- 1University of Arizona, Medicine, Division of Pulmonary , 1501 Campbell Ave. , PO Box 245030 , Tucson, Arizona, United States , 85724-5030 , 520-626-6115 , 520-626-6970 ; cwong@deptofmed.arizona.edu.
Abstract
Approximately 150 to 250 migrants die each year while attempting to cross the border from Mexico to the Southwest United States. Many border crossers survive the journey, but some develop life threatening medical complications. Such complications have been subject to little formal analysis. Accordingly, we sought to determine the causes of critical illness in this population and to analyze the hospital course and outcomes of these patients.
We retrospectively identified border crossers admitted to the intensive care units (ICU) of two major teaching hospitals in southern Arizona. We recorded admitting diagnoses, severity of illness, length of stay (LOS), resource use, discharge diagnoses, andmortality.
Our investigation identified 55 admissions to adult ICUs between January 1, 2010 and December 31, 2012. The median age of patients was 27 years. The median hospital LOS was 7 days, with a median ICU LOS of 3 days. The median temperature on arrival to the emergency department was 36.8˚C. The most common admission diagnoses included trauma (40), rhabdomyolysis (27), acute liver injury (25), dehydration (24), acute kidney injury (19), and encephalopathy (17). Thirteen patients presented with respiratory failure; six patients with severe sepsis; and two with septic shock. Nineteen patients required ventilator support during their hospital stay, and thirty required at least one surgical intervention. One patient required renal replacement therapy. The median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 6. All but one patient survived to discharge from the hospital.
Border crossers are a unique population of young individuals exposed to high temperatures and extreme conditions. Our review of border crosser admissions showed that most patients demonstrated signs of dehydration and leukocytosis despite a normal median temperature. The median ICU stay was short despite a high number of patients requiring ventilator support and surgical intervention. Only one death occurred in this cohort.
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