Evaluation of Prognostic Factors for Prolonged Intensive Care Unit Hospitalization After Trauma: Roles of Hemorrhagic Burden and Admission Laboratory Abnormalities

Background and Objectives: Prolonged intensive care unit (ICU) hospitalization after trauma reflects sustained critical-care needs, but early prognostic assessment remains challenging. The primary objective was to identify factors associated with prolonged ICU hospitalization (≥7 days) using admission characteristics and treatment information available during the first 24 h. The secondary objective was to explore whether these associations differed according to a composite score of admission laboratory abnormalities (CE score). Materials and Methods: This retrospective cohort study included 2638 patients admitted between 1 January 2006 and 31 December 2021 from a prospectively maintained Level I trauma registry. Prolonged ICU hospitalization was defined as ICU length of stay (LOS) ≥7 days. Multivariable regression evaluated independent associations between early clinical factors and prolonged ICU hospitalization. Exploratory interaction analyses evaluated effect modification by the CE score, a composite of admission laboratory abnormalities. In-hospital deaths were retained in the primary cohort. The potential influence of in-hospital death on ICU LOS was evaluated in an additional survivor-restricted sensitivity analysis. Sensitivity analyses used ICU LOS ≥ 10 days and log-transformed ICU LOS.