INTRODUCTION: Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted patients. METHODS: We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement, and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU and hospital LOS). RESULTS: Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection, fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients with ICH the volume of the initial bleed was significant in some models. CONCLUSION: LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary to eliminate "preventable" complications and minimize LOS after brain hemorrhage.
INTRODUCTION: Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted patients. METHODS: We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement, and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU and hospital LOS). RESULTS: Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection, fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients with ICH the volume of the initial bleed was significant in some models. CONCLUSION: LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary to eliminate "preventable" complications and minimize LOS after brain hemorrhage.
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R Legall; A Morris; R Spragg Journal: Am J Respir Crit Care Med Date: 1994-03 Impact factor: 21.405
Authors: Andrew M Naidech; Kurt T Kreiter; Nazli Janjua; Noeleen Ostapkovich; Augusto Parra; Christopher Commichau; E Sander Connolly; Stephan A Mayer; Brian-Fred M Fitzsimmons Journal: Stroke Date: 2005-01-20 Impact factor: 7.914
Authors: Jonathan A Friedman; Mark A Pichelmann; David G Piepgras; Jon I McIver; L Gerard Toussaint; Robyn L McClelland; Douglas A Nichols; Fredric B Meyer; John L D Atkinson; Eelco F M Wijdicks Journal: Neurosurgery Date: 2003-05 Impact factor: 4.654
Authors: Jan Claassen; An Vu; Kurt T Kreiter; Robert G Kowalski; Evelyn Y Du; Noeleen Ostapkovich; Brian-Fred M Fitzsimmons; E Sander Connolly; Stephan A Mayer Journal: Crit Care Med Date: 2004-03 Impact factor: 7.598
Authors: Jennifer A Frontera; Andres Fernandez; J Michael Schmidt; Jan Claassen; Katja E Wartenberg; Neeraj Badjatia; Augusto Parra; E Sander Connolly; Stephan A Mayer Journal: Neurosurgery Date: 2008-01 Impact factor: 4.654
Authors: Craig S Anderson; Yining Huang; Ji Guang Wang; Hisatomi Arima; Bruce Neal; Bin Peng; Emma Heeley; Christian Skulina; Mark W Parsons; Jong Sung Kim; Qing Ling Tao; Yue Chun Li; Jian Dong Jiang; Li Wen Tai; Jin Li Zhang; En Xu; Yan Cheng; Stephane Heritier; Lewis B Morgenstern; John Chalmers Journal: Lancet Neurol Date: 2008-04-07 Impact factor: 44.182
Authors: Christopher L Kramer; Marianna Pegoli; Jay Mandrekar; Giuseppe Lanzino; Alejandro A Rabinstein Journal: Neurocrit Care Date: 2017-02 Impact factor: 3.210
Authors: Krishma Adatia; Romergryko G Geocadin; Ryan Healy; Wendy Ziai; Luciano Ponce-Mejia; Mirinda Anderson-White; Dhaval Shah; Batya R Radzik; Caitlin Palmisano; Charles W Hogue; Charles Brown; Lucia Rivera-Lara Journal: Crit Care Med Date: 2018-08 Impact factor: 7.598
Authors: Matthew Ferguson; Matt T Bianchi; Raoul Sutter; Eric S Rosenthal; Sydney S Cash; Peter W Kaplan; M Brandon Westover Journal: Neurocrit Care Date: 2013-04 Impact factor: 3.210
Authors: Kathryn A Morbitzer; J Dedrick Jordan; Kelly A Sullivan; Emily A Durr; Casey M Olm-Shipman; Denise H Rhoney Journal: Neurocrit Care Date: 2016-10 Impact factor: 3.210
Authors: Jonathan Elmer; Peter Hou; Susan R Wilcox; Yuchiao Chang; Hannah Schreiber; Ikenna Okechukwu; Octávio Pontes-Neto; Ednan Bajwa; Dean R Hess; Laura Avery; Maria Alejandra Duran-Mendicuti; Carlos A Camargo; Steven M Greenberg; Jonathan Rosand; Daniel J Pallin; Joshua N Goldstein Journal: Crit Care Med Date: 2013-08 Impact factor: 7.598
Authors: Ravi Garg; Shyam Prabhakaran; Jane L Holl; Yuan Luo; Roland Faigle; Konrad Kording; Andrew M Naidech Journal: J Stroke Cerebrovasc Dis Date: 2018-09-07 Impact factor: 2.136