BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a neurologic emergency that typically warrants initial monitoring in a critical care setting. The aim of this study is to identify clinical and radiologic features on admission that predict a protracted critical care admission following aSAH. METHODS: Exploratory posthoc analysis was performed on the 413 patients enrolled in Clazosentan to Overcome Neurological iSChemia and Infarction OccUrring after Subarachnoid hemorrhage (CONSCIOUS-1), a prospective randomized control trial of clazosentan for the prevention of vasospasm after aSAH. The association between potential clinical and radiographic covariates, and the length of stay (LOS) in a critical care unit after aSAH was determined using a Cox proportional hazards model. Covariates with a significance level of p < 0.20, on univariate analysis, were entered into a multivariate forward conditional analysis to identify independent predictors of prolonged LOS. RESULTS: The mean LOS was 12.6 ± 10.6 days. On multivariate analysis, age (hazard ratio [HR] 1.01, 95 % confidence interval [CI] 1.00-1.02; p = 0.032), a history of hypertension (HR 1.30, CI 1.01-1.67; p = 0.045), and a World Federation of Neurosurgical Societies Score of IV-V on admission (HR 1.38, CI 1.05-1.81; p = 0.02) were the clinical features associated with a greater critical care LOS following aSAH. Intracerebral hemorrhage (HR 1.50, CI 1.03-2.21; p = 0.004) and increasing intraventricular clot burden (HR 1.08, CI 1.03-1.14; p = 0.037) on admission computed tomography were the radiologic features associated with prolonged LOS. CONCLUSIONS: We have identified several early risk factors associated with a prolonged critical care stay following aSAH.
BACKGROUND:Aneurysmal subarachnoid hemorrhage (aSAH) is a neurologic emergency that typically warrants initial monitoring in a critical care setting. The aim of this study is to identify clinical and radiologic features on admission that predict a protracted critical care admission following aSAH. METHODS: Exploratory posthoc analysis was performed on the 413 patients enrolled in Clazosentan to Overcome Neurological iSChemia and Infarction OccUrring after Subarachnoid hemorrhage (CONSCIOUS-1), a prospective randomized control trial of clazosentan for the prevention of vasospasm after aSAH. The association between potential clinical and radiographic covariates, and the length of stay (LOS) in a critical care unit after aSAH was determined using a Cox proportional hazards model. Covariates with a significance level of p < 0.20, on univariate analysis, were entered into a multivariate forward conditional analysis to identify independent predictors of prolonged LOS. RESULTS: The mean LOS was 12.6 ± 10.6 days. On multivariate analysis, age (hazard ratio [HR] 1.01, 95 % confidence interval [CI] 1.00-1.02; p = 0.032), a history of hypertension (HR 1.30, CI 1.01-1.67; p = 0.045), and a World Federation of Neurosurgical Societies Score of IV-V on admission (HR 1.38, CI 1.05-1.81; p = 0.02) were the clinical features associated with a greater critical care LOS following aSAH. Intracerebral hemorrhage (HR 1.50, CI 1.03-2.21; p = 0.004) and increasing intraventricular clot burden (HR 1.08, CI 1.03-1.14; p = 0.037) on admission computed tomography were the radiologic features associated with prolonged LOS. CONCLUSIONS: We have identified several early risk factors associated with a prolonged critical care stay following aSAH.
Authors: David A Wilson; Peter Nakaji; Adib A Abla; Timothy D Uschold; David J Fusco; Mark E Oppenlander; Felipe C Albuquerque; Cameron G McDougall; Joseph M Zabramski; Robert F Spetzler Journal: Neurosurgery Date: 2012-10 Impact factor: 4.654
Authors: Michael N Diringer; Thomas P Bleck; J Claude Hemphill; David Menon; Lori Shutter; Paul Vespa; Nicolas Bruder; E Sander Connolly; Giuseppe Citerio; Daryl Gress; Daniel Hänggi; Brian L Hoh; Giuseppe Lanzino; Peter Le Roux; Alejandro Rabinstein; Erich Schmutzhard; Nino Stocchetti; Jose I Suarez; Miriam Treggiari; Ming-Yuan Tseng; Mervyn D I Vergouwen; Stefan Wolf; Gregory Zipfel Journal: Neurocrit Care Date: 2011-09 Impact factor: 3.210
Authors: Y B W E M Roos; M G W Dijkgraaf; K W Albrecht; L F M Beenen; R J M Groen; R J de Haan; M Vermeulen Journal: Stroke Date: 2002-06 Impact factor: 7.914
Authors: N J Solenski; E C Haley; N F Kassell; G Kongable; T Germanson; L Truskowski; J C Torner Journal: Crit Care Med Date: 1995-06 Impact factor: 7.598