Newly Escalated Psychotropic Medications in the Trauma Intensive Care Unit: Prescribing Patterns During Care Transitions

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BACKGROUND: Previous retrospective studies involving mixed intensive care unit (ICU) populations found antipsychotic continuation rates ranging from 21% to 61% at hospital discharge. Surgical ICU admission was cited as a risk factor for antipsychotic continuation, although data in the trauma population are limited. OBJECTIVE: The purpose of this study was to evaluate the number of critically ill trauma patients with escalated psychotropic medications in the surgical ICU and the rate of continuation at ICU transfer and hospital discharge. METHODS: This single-center, retrospective, Institutional Review Board (IRB)-approved study examined adult trauma patients admitted to the surgical ICU at an urban Level 1 Trauma and Academic Medical Center from December 1, 2021, to May 31, 2023. Patients were excluded if they had a history of select psychiatric disorders or were in the ICU for less than 48 hours. Prior psychotropic medication use was noted, and escalation was defined as a new or increased dose of psychotropic medication. The incidence of delirium and agitation was recorded to assess the indication for psychotropic medication escalation. The primary and secondary outcomes were the percentage of patients with escalated psychotropic medications in the ICU who were continued on therapy at the time of ICU transfer and hospital discharge, respectively. RESULTS: Four hundred and twenty-four patients admitted to the surgical ICU were included; 51.4% were escalated on a psychotropic medication while in the ICU. Nearly 35% and 31.8% of the overall population were continued on psychotropic medication at ICU and hospital discharge, respectively. Of patients on psychotropic medication at hospital discharge, 55.6% were discharged to acute rehabilitation, 28.9% to home, and 13.3% to long-term care. CONCLUSION AND RELEVANCE: Escalation of psychotropic medications was common in trauma patients admitted to the surgical ICU. Further investigation into the appropriateness of psychotropic medication prescription during care transitions is needed.

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