1324: ABCDEF Bundle Elements and Mobility During Admission: Mortality Effects on the Critically Injured

Abstract

INTRODUCTION: ABCDEF bundle compliance correlates with decreased mortality in the critically ill, but it is unclear which bundle elements are most critical. We studied this question using ABC-123, an EPIC-EMR real-time score assigning 1-3 points per bundle element with higher numbers being better, and improvement in patient mobility during admission (IMA). METHOD(S): We reviewed 6 months of prospectivelycollected data on critically injured adults at an ACS-verified level I trauma center, including demographics, injury severity, Richmond Agitation and Sedation (RASS) Score, Confusion Assessment Method-ICU (CAM-ICU), maximum daily ABC- 123 score (ABC-MAX), and mobility level (bedrest/dangle/ stand/out of bed to chair/ambulate). ABC-123 score includes CPOT assessment, performance of SAT/SBT, reducing IV infusions for sedation, CAM-ICU score, compliance with mobility protocol, and family updates. Patients with mobility level improvement during admission were considered IMA+. Hospital mortality was the endpoint for logistic regression with ISS, head AIS, penetrating trauma, gender, age, ABCMAX subscores, and IMA. RESULT(S): We reviewed 172 patients (69.8% male, 16.3% penetrating, mean age 50.3+/-20.9 years, ISS 18.5+/-9.5, head AIS 2.3+/-2.5). 66.9% had delirium and 11.0% died. IMA+ patients had lower mortality than IMA- (1/48 [2.1%] vs. 18/124 [14.5%], p=0.027 [Fisher's exact]). ISS (OR 1.06[95%CI 1.03-1.10,p<0.001]), head AIS (OR 1.17 [1.00-1.36,p=0.049]), penetrating injury (OR 2.58 [1.18- 5.66,p=0.018]), female gender (OR 3.31 [1.94-5.65,p<0.001]) age in decades (OR 1.57 [1.34-1.82,p<0.001]), A score (OR 2.91 [1.10, 7.72,p=0.032]), and C score (OR 2.14 [1.01- 4.54,p=0.048]) were associated with increased mortality. D score (OR 0.45 [0.33-0.61,p<0.001]), E score (OR 0.69 [0.52-0.92,p=0.012]) and IMA (OR 0.14 [0.062- 0.34,p<0.001]) were associated with decreased mortality. CONCLUSION(S): D subscore (indicating CAM negative status), E subscore (indicating compliance with mobility protocol) and improvement in mobility during admission are strongly associated with reduced mortality in critically injured patients. Additional study is needed to understand the relationship between A subscore (indicating low CPOT score) and C subscore (indicating less use of continuous IV infusions for sedation) and increased mortality.