Predictors of prolonged observation in pregnant trauma patients in the emergency department.

BACKGROUND

Trauma during pregnancy presents unique clinical challenges due to physiological adaptations and the need to ensure fetal well-being. Although guidelines recommend a minimum period of maternal and fetal monitoring following trauma, the factors associated with prolonged emergency department (ED) observation in pregnant trauma patients remain insufficiently defined. Identifying these factors may help optimize clinical decision-making and resource utilization in emergency care settings.

METHODS

This retrospective cohort study was conducted in a tertiary-care emergency department between January 2014 and January 2024. Patients were categorized according to ED observation duration as ≤6 hours or >6 hours. Demographic characteristics and clinical variables, including Injury Severity Score (ISS), gestational age, RhD status, trauma characteristics, and consultation requirements, were recorded. Univariate and multivariable logistic regression analyses were performed to identify predictors of prolonged ED observation.

RESULTS

A total of 459 pregnant trauma patients were included in the analysis, of whom 238 (51.9%) were observed in the ED for more than 6 hours. Patients with prolonged observation had a significantly higher gestational age than those observed for ≤6 hours (median 24 weeks [interquartile range (IQR): 15-32] vs. 17 weeks [IQR: 11-23], p<0.001). In multivariable analysis, higher ISS (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.08-1.35, p<0.001), advancing gestational age (OR: 1.07 per week, 95% CI: 1.04-1.09, p<0.001), and RhD negativity (OR: 3.84, 95% CI: 1.33-11.14, p=0.013) were independently associated with ED observation exceeding 6 hours. Although the number of consultations was significantly associated with prolonged observation in univariate analysis, it did not remain an independent predictor after multivariable adjustment.

CONCLUSION

Higher ISS, advancing gestational age, and RhD negativity were independently associated with emergency department observation lasting more than 6 hours among pregnant trauma patients.