Injury patterns and epidemiology of orthopedic trauma in polytrauma ICU patients: A 10-year retrospective analysis at major trauma hospital.

Abstract

Polytrauma requiring intensive care remains a leading cause of morbidity and mortality, particularly among patients with orthopedic injuries. Despite advances in trauma systems and surgical management, outcomes for this cohort are influenced by complex interactions between injury burden, physiological status, and pre-existing comorbidities. There remains limited evidence focused specifically on predictors of outcome within orthopedic trauma patients admitted to the intensive care unit (ICU). This retrospective cohort study analyzed all adults (≥18 years) admitted with orthopedic trauma to the ICU of a major Irish tertiary trauma centre between January 2011 and December 2020. Orthopedic injuries included fractures, dislocations, or musculoskeletal trauma requiring specialist management. Demographic, clinical, and injury-related data were extracted from institutional databases. Outcomes assessed were 30-day, 90-day, and 1-year mortality, complication burden (graded by the Adapted Clavien-Dindo in Trauma [ACDiT] score), and discharge destination. Multivariate regression was used to identify independent predictors of adverse outcomes. Of 720 trauma patients admitted to the ICU over 10 years, 458 with orthopedic injuries were included. The mean age was 56.2 years; 63.8 % were male, and two-thirds had at least one comorbidity. The most common mechanisms were low-level falls and road traffic accidents. The median Injury Severity Score was 16, and 23.4 % required mechanical ventilation. One-year survival was 79.7 %. Key predictors of mortality and complications included advanced age, cervical spine injury, lower Glasgow Coma Scale, higher ASA and ISS, mechanical ventilation, malignancy, and polytrauma. Most patients returned home at discharge, though a significant minority required institutional care or died in-hospital. Orthopedic polytrauma patients admitted to ICU represent a high-risk group with substantial mortality and complication rates, particularly among the elderly and those with severe physiological compromise. Early identification of prognostic factors such as age, ISS, GCS, ASA, and need for ventilation may inform tailored management strategies and support improved risk stratification in this vulnerable population.