(1582) Chaos and Consequences: Intensive Care Outcomes in the Wake of a Mass Casualty Event

Introduction: The combination of the SARS-CoV-2 virus and the U.S. healthcare system triggered a biological mass casualty disaster (MCD) that killed more than 1 million people. The effects of MCDs are felt by those directly impacted by the disaster, high-risk populations who are excessively harmed in the peri-disaster period, and the institutions who care for them. Historically, Intensive Care Units (ICUs) have been under disproportionate stress, resulting in increased adverse outcomes for ICU patients. We hypothesized that during MCD, there would be spillover effects leading to worse outcomes in patients admitted to the hospital for non-MCD-related treatments.

Methods: Vizient Clinical Database (CDB) was used to obtain the total admissions to an ICU, and for each admission demographic data, all ICD-10 diagnoses, length of stay (LOS), expected LOS, number of ICU days, total cost of admission, and direct cost were obtained. The data came from a single tertiary academic center in 2019 and 2020 to compare a pre-disaster baseline to MCD data.
Data was collected for patients admitted with a diagnosis of “trauma” and “traumatic injury.” For the year 2020, any patients with a diagnosis of COVID-19 were excluded. As the natural history of recovery from traumatic injuries would not be impacted by the biological MCD, this cohort was chosen to represent a non-MCD-associated admission.
Data were summarized with mean and standard deviation. Independent sample two-sided t-tests were used to compare subgroup means. All cost data were adjusted for inflation using the consumer price index.

Results: A total of 1,108 patients were admitted with a trauma diagnosis in 2019 and 1,398 in 2020.
For patients admitted with a diagnosis of traumatic injury in 2020, the mean LOS was 2.1 days longer than in 2019, (p-value < 0.05) with no difference in the expected LOS determined by illness severity. The total cost of admission was $10,000 more in 2020 than 2019 (p-value 0. < 0.05), with a notable 4% increase in the number of patients identified with low socioeconomic status. The direct cost was found to be $3,763 more in 2020 than 2019 (p-value < 0.05).

Conclusions: In a single-center study, patients admitted to the ICU with non-MCD-associated diagnoses had increased length of stay and increased cost of care.