{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T13:13:34Z","timestamp":1780060414655,"version":"3.54.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unplanned ICU admissions (UA-ICU) is a TQIP metric associated with increased morbidity, mortality, and resource utilization. Despite identification of certain predictive factors in prior publications, gaps remain in identifying patients at-risk, particularly once in-hospital and outside the emergency room setting. Our study investigates novel predictors and emphasizes outcomes in UA-ICU for trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study. Single ACS-verified Level 1 Trauma Center (2019-2023). N = 140 UA-ICU after initial non-ICU hospital ward admission and 140 controls never admitted to ICU propensity-matched for age, gender, mechanism of injury (MOI), ISS, and top two highest abbreviated injury values (AIS). We compared variables including demographic, injuries, comorbidities, laboratory, and pharmacology. Statistical analysis was performed utilizing SPSS-28 (Armok, NY) software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      UA-ICU patients demonstrated higher mortality (22.1% vs 1.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), longer length of stay (LOS) (10 vs 3 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and fewer discharges home (33.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Comorbidity predictors included cirrhosis, active cancer diagnosis, CHF, and home medication for seizure and loop diuretics. Between 48-72\u00a0h post-admission, UA-ICU had higher heart rates (107 vs 96\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), lower hemoglobin (11 vs 13,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), lower platelets (193 vs 229,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002) and supplemental oxygen requirements (2L vs 0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our study affirms established predictors and introduces novel indicators for UA-ICU. Length of stay, discharge other than home, and mortality outcomes are consistent with research linking UA-ICU to prolonged hospitalization and adverse outcomes. Early detection, dynamic monitoring, and interdisciplinary interventions should coalesce to mitigate preventable UA-ICU and conserve resources. We proposed integration of additional predictors into clinical practice\/scoring systems to optimize patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251387158","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T19:50:36Z","timestamp":1760730636000},"page":"1162-1168","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Predicting Unplanned ICU Admission in Trauma: Early Warning Signs on the Floor"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5839-6642","authenticated-orcid":false,"given":"Clark D.","family":"Bailey","sequence":"first","affiliation":[{"name":"University of Tennessee Health Science Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor H.","family":"Boruff","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily N.","family":"Rhoton","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin T.","family":"Lambert","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob D.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"University of Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Alva J.","family":"Bethurum","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy A.","family":"Howk","sequence":"additional","affiliation":[{"name":"University of Tennessee Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"King","sequence":"additional","affiliation":[{"name":"University of Tennessee Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Heidel","sequence":"additional","affiliation":[{"name":"University of Tennessee Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lou M.","family":"Smith","sequence":"additional","affiliation":[{"name":"University of Tennessee Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Trauma quality improvement program ACS Accessed January 20 2025.https:\/\/www.facs.org\/quality-programs\/qi-resources\/case-studies\/keep-calm-and-stay-out-of-the-icu-a-comprehensive-approach-to-reducing-unplanned-icu-admissions\/"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0b013e31829247e7"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2007.11.015"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2007.12.019"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0b013e31828a217b"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0b013e31822d751e"},{"key":"e_1_3_3_8_2","unstructured":"Trauma quality improvement program. 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