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J Trauma Acute Care Surg. 2020 Jan 15. doi: 10.1097/TA.0000000000002588. [Epub ahead of print]

Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre-post study.

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Faculty of Medicine, Dalhousie University, Halifax, NS, Canada, B3H 4R2.
Trauma Nova Scotia, Nova Scotia Health Authority, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, Canada, B3H 2Y9.
Departments of Critical Care and Emergency Medicine, Dalhousie University, Halifax, NS, Canada, B3H 4R2.



Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes.


We conducted a retrospective pre-post study of adult trauma patients (>18 years old) admitted to ICU at a level 1 trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], ventilator-free days) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models.


Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 to 92 years (mean 49.0 ± 20.4 years) and 74.3% were male. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p=0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (OR = 0.43, 95% CI 0.24-0.79, p=0.006) or in-hospital (OR = 0.55, 95% CI 0.32-0.94, p= 0.03). In-hospital LOS, ICU LOS, ICU-free days, and number of ventilator-free days were similar between the two groups.


Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.Level III, therapeutic.

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