1325: ABC-MAX (ABCDEF Bundle Compliance) Score and Mobility Level Are Associated With Decreased Mortality

Abstract

INTRODUCTION: ABCDEF bundle compliance correlates with decreased mortality and ventilator use in the critically ill, but measurement tools are lacking. ABC-123, an EPIC-EMR real-time score assigns 1-3 points per bundle element, with higher numbers being better. We hypothesized that increases in maximum daily ABC-123 score (ABC-MAX) and mobility would be associated with decreased mortality in critically injured patients. METHOD(S): We reviewed prospectively-collected data on critically injured adults at an ACS-verified level I trauma center for 6 months, including demographics, injury severity, ventilator and restraint use, Richmond Agitation and Sedation (RASS) Score, Confusion Assessment Method-ICU (CAMICU), ABC-MAX, and mobility level (bedrest/dangle/stand/out of bed to chair/ambulate). ABC-MAX is the maximum daily ABC-123 score, including CPOT assessment, performance of SAT/SBT, reducing use of IV infusions for sedation, CAMICU score, compliance with mobility protocol, and family updates. Hospital mortality was the endpoint for logistic regression with ISS, head AIS, surgery during admission, penetrating trauma, gender, age, restraint and ventilator use, ABC-MAX and mobility level. RESULT(S): We reviewed 172 patients (69.8% male, 16.3% penetrating, injuries: 12.8% solid organ, 5.8% small bowel, 4.1% colon, 12.2% vascular, mean age 50.3+/-20.9 years, ISS 18.5+/-9.5, head AIS 2.3+/-2.5). 48.3% underwent surgery (12.2% laparotomy including 8.1% damage control). 66.9% had delirium, 48.8% had restraints used, 51.7% were ventilated, and 11.0% died. ISS (OR 1.09[95%CI 1.06- 1.13, p<0.001]), head AIS (OR 1.32 [1.12-1.55, p=0.001]), penetrating injury (OR 2.47 [1.22-5.00, p=0.012]), female gender (OR 4.05 [2.39-6.80, p<0.001]) and age in decades (OR 1.33 [1.16-1.52, p<0.001]) were associated with increased mortality. Each point increase in ABC-Max (OR 0.90[0.84-0.98, p=0.012) or in mobility level (OR 0.47 [0.23-0.97, p=0.041]) was associated with decreased mortality risk. CONCLUSION(S): ABC-MAX (ABCDEF bundle compliance) score and mobility level are associated with reduced mortality in critically injured patients.