In a prospective observational study [9], there were discordant predictions with regard to futility of survival and quality of life between under doctors and nurses in 21% of ICU patients. Only 9 to 15% of survivors of ICU stay where health care professionals had considered treatment futile actually reported bad quality of life six months later. On the other hand, physician estimates of ICU survival can be powerful predictors of ICU mortality when compared with illness severity, organ dysfunction and the use of inotropic drugs, possibly by contributing to more ‘do not resuscitate’ directives in instances of cardiac arrest, and more likely withdrawal of dialysis, pharmacological support, and mechanical ventilation [10].

That patients aged 65 years and older accounted for almost 40% of the ILOS>30 group was reflective of our admission population, where these elderly patients comprised 28% of all trauma admissions to our institution. Older trauma patients have been recognized as having a higher risk of dying when chronic medical conditions exist compared with those without chronic conditions, and this relation between mortality and pre-existing medical conditions is more apparent when these patients sustain less severe injuries [11]. Studies in non-trauma ICU cohorts support the conclusion that age in and of itself does not predict poor outcome [12-14]. Higgins and colleagues [14] determined that the need for ventilation at 24 hours, trauma and emergency surgery admissions, severity of illness, and prolonged pre-ICU stays were independent predictors of prolonged stay, and not age in itself.

Pre-hospital functional status has also been found to be an important predictor of poor outcome in ICU patients [15-17].There were several limitations of this study. One was the lack of data on long-term outcome and pre-injury functional status. We also did not have prospective information on prognostic indicators of ICU survivability or measures of organ dysfunction with time in the ICU. Also, we could not assess the degree of adherence to evidence-based practices known to reduce ICU morbidity and mortality such as glycemic control, sedation protocols, ventilator practices, and transfusion and phlebotomy practices [18]. Further, ICU LOS was influenced to a certain extent by discharge planning arrangements with insurance payers and transfer facilities.

The lack of prospective time-dependent data regarding organ dysfunction and the degree of adherence to evidence-based guidelines makes it difficult Carfilzomib to determine to what extent the acquired ICU complications were a result of sub-optimal ICU care rather than nature of disease due to the injuries sustained on admission.Finally, the definitions of certain pre-existing conditions such as cardiac and pulmonary disease lacked objective criteria.