OBJECTIVE: Patients with aneurysmal subarachnoid hemorrhage (aSAH) require management in centers with neurosurgical expertise necessitating emergent interhospital transfer (IHT). Our objective was to compare outcomes in aSAH IHTs to our institution with aSAH admissions from our institutional emergency department (ED). METHODS: Data for consecutive patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed from a prospectively obtained database. We compared in-hospital mortality and functional outcomes at first clinical appointment post-aSAH (30-120 days) using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5) in ED admissions with IHTs. RESULTS: A total of 1134 consecutive patients with aSAH were included in analysis (ED 40.1%, IHT 59.9%). Direct ED admissions had a higher incidence of poor Hunt and Hess grade (4/5) and major medical comorbidities, with no significant differences between the 2 groups in age, intraventricular hemorrhage, and hydrocephalus. In-hospital mortality for ED admissions (14.9%) was significantly lower than that for IHTs (20.5%), with 1.8 times greater adjusted odds of survival after multivariate analysis (P = .001). Emergency department admissions had nearly 2-fold greater odds of good outcomes (odds ratio, 1.89; P < .001) after multivariate analysis. CONCLUSIONS: Our institutional ED SAH admissions had significantly better outcomes than did IHTs, suggesting that delays in optimizing care before transfer could deleteriously impact outcomes.
OBJECTIVE:Patients with aneurysmal subarachnoid hemorrhage (aSAH) require management in centers with neurosurgical expertise necessitating emergent interhospital transfer (IHT). Our objective was to compare outcomes in aSAH IHTs to our institution with aSAH admissions from our institutional emergency department (ED). METHODS: Data for consecutive patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed from a prospectively obtained database. We compared in-hospital mortality and functional outcomes at first clinical appointment post-aSAH (30-120 days) using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5) in ED admissions with IHTs. RESULTS: A total of 1134 consecutive patients with aSAH were included in analysis (ED 40.1%, IHT 59.9%). Direct ED admissions had a higher incidence of poor Hunt and Hess grade (4/5) and major medical comorbidities, with no significant differences between the 2 groups in age, intraventricular hemorrhage, and hydrocephalus. In-hospital mortality for ED admissions (14.9%) was significantly lower than that for IHTs (20.5%), with 1.8 times greater adjusted odds of survival after multivariate analysis (P = .001). Emergency department admissions had nearly 2-fold greater odds of good outcomes (odds ratio, 1.89; P < .001) after multivariate analysis. CONCLUSIONS: Our institutional ED SAH admissions had significantly better outcomes than did IHTs, suggesting that delays in optimizing care before transfer could deleteriously impact outcomes.
Authors: Menno Robbert; Menno R Germans; Jantien Hoogmoed; H A Stéphanie van Straaten; Bert A Coert; W Peter Vandertop; Dagmar Verbaan Journal: J Neurol Date: 2013-12-24 Impact factor: 4.849
Authors: Peter Le Roux; David K Menon; Giuseppe Citerio; Paul Vespa; Mary Kay Bader; Gretchen M Brophy; Michael N Diringer; Nino Stocchetti; Walter Videtta; Rocco Armonda; Neeraj Badjatia; Julian Böesel; Randall Chesnut; Sherry Chou; Jan Claassen; Marek Czosnyka; Michael De Georgia; Anthony Figaji; Jennifer Fugate; Raimund Helbok; David Horowitz; Peter Hutchinson; Monisha Kumar; Molly McNett; Chad Miller; Andrew Naidech; Mauro Oddo; DaiWai Olson; Kristine O'Phelan; J Javier Provencio; Corinna Puppo; Richard Riker; Claudia Robertson; Michael Schmidt; Fabio Taccone Journal: Intensive Care Med Date: 2014-08-20 Impact factor: 17.440
Authors: Peter Le Roux; David K Menon; Giuseppe Citerio; Paul Vespa; Mary Kay Bader; Gretchen M Brophy; Michael N Diringer; Nino Stocchetti; Walter Videtta; Rocco Armonda; Neeraj Badjatia; Julian Böesel; Randall Chesnut; Sherry Chou; Jan Claassen; Marek Czosnyka; Michael De Georgia; Anthony Figaji; Jennifer Fugate; Raimund Helbok; David Horowitz; Peter Hutchinson; Monisha Kumar; Molly McNett; Chad Miller; Andrew Naidech; Mauro Oddo; DaiWai Olson; Kristine O'Phelan; J Javier Provencio; Corinna Puppo; Richard Riker; Claudia Robertson; Michael Schmidt; Fabio Taccone Journal: Neurocrit Care Date: 2014-12 Impact factor: 3.210