Introduction: Our surgical intensive care unit (SICU) triage scheme for patients with isolated severe head and neck injuries (ISH hence, a considerable number of these patients are admitted to different settings. This study will evaluate the characteristics and outcomes of ISH&NI patients admitted to the acute ward (AW), step down unit (SDU) and SICU. Methods: Adults with blunt, ISH&NI maximum abbreviated injury scale score (AIS) ≥3 (MAIS3+) for the head and neck region and no other MAIS3+ injuries admitted to the AW, SDU and SICU of a level I trauma center (01/01/2020-12/31/2023) were selected from the trauma registry. We used univariate and multivariate analyses (alpha=0.05) to identify associations of demographics, injury severity, co-morbidities, and outcomes with initial inpatient disposition. Results: The 968 ISH&NI patients were triaged 53.8% of the times to the AW, 23.9% to the SDU and 22.3% to the SICU. Head and neck AIS 3, 4 and 5 represented 49.6%, 33.9%, and 16.5% of the cohort, respectively. Those admitted to the SICU were younger than those admitted to the SDU and AW (Age >60 56.9% vs 64.9% and 68.9% respectively) and more likely to have AIS 5 injuries (58.8% vs 28.1% and 13.1%, respectively). Mortality for the entire cohort was 11.4% and was associated with AIS 3,4 and 5 (4.0%, 8.5%, and 39.4%, respectively) and AW, SDU and SICU disposition (2.9%, 4.3%, 39.4%, respectively) but not with age or sex. A multiple logistic regression analysis for the prediction of death, with SDU disposition as reference group, showed increased adjusted odds of death for age ≥60 (OR 2.70), AIS 5 (OR 5.65), and SICU disposition (OR 13.28) (Area under de curve 0.88). AIS 4 and AW disposition did not reach statistical significance. Conclusions: Triaging head/neck injuries represents a challenge for trauma providers. Our study found that while higher injury severity was independently associated with increased mortality, our current triaging criteria manages to concentrate the patients at higher risk of death that require higher intensity of care in the SICU, allocating the remaining of the population to a less intensity of care environment, and maintaining adequate outcomes.
Winalski et al. (Sun,) studied this question.