Michael E Reznik1, Ali Mahta1, J Michael Schmidt2, Hans-Peter Frey2, Soojin Park2, David J Roh2, Sachin Agarwal2, Jan Claassen3. 1. Department of Neurology, Warren Alpert Medical School at Brown University, Providence, RI, USA. 2. Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8GS-300, New York, NY, 10032, USA. 3. Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital Building, Suite 8GS-300, New York, NY, 10032, USA. jc1439@cumc.columbia.edu.
Abstract
BACKGROUND: Agitation is common after subarachnoid hemorrhage (SAH) and may be independently associated with outcomes. We sought to determine whether the duration of agitation and fluctuating consciousness were also associated with outcomes in patients with SAH. METHODS: We identified all patients with positive Richmond Agitation Sedation Scale (RASS) scores from a prospective observational cohort of patients with SAH from 2011 to 2015. Total duration of agitation was extrapolated for each patient using available RASS scores, and 24-h mean and standard deviation (SD) of RASS scores were calculated for each patient. We also calculated each patient's duration of substantial fluctuation of consciousness, defined as the number of days with 24-h RASS SD > 1. Patients were stratified by 3-month outcome using the modified Rankin scale, and associations with outcome were assessed via logistic regression. RESULTS: There were 98 patients with at least one positive RASS score, with median total duration of agitation 8 h (interquartile range [IQR] 4-18), and median duration of substantially fluctuating consciousness 2 days (IQR 1-3). Unfavorable 3-month outcome was significantly associated with a longer duration of fluctuating consciousness (odds ratio [OR] per day, 1.51; 95% confidence interval [CI], 1.04-2.20; p = 0.031), but a briefer duration of agitation (OR per hour, 0.94; 95% CI, 0.89-0.99; p = 0.031). CONCLUSION: Though a longer duration of fluctuating consciousness was associated with worse outcomes in our cohort, total duration of agitation was not, and may have had the opposite effect. Our findings should therefore challenge the intensity with which agitation is often treated in SAH patients.
BACKGROUND:Agitation is common after subarachnoid hemorrhage (SAH) and may be independently associated with outcomes. We sought to determine whether the duration of agitation and fluctuating consciousness were also associated with outcomes in patients with SAH. METHODS: We identified all patients with positive Richmond Agitation Sedation Scale (RASS) scores from a prospective observational cohort of patients with SAH from 2011 to 2015. Total duration of agitation was extrapolated for each patient using available RASS scores, and 24-h mean and standard deviation (SD) of RASS scores were calculated for each patient. We also calculated each patient's duration of substantial fluctuation of consciousness, defined as the number of days with 24-h RASS SD > 1. Patients were stratified by 3-month outcome using the modified Rankin scale, and associations with outcome were assessed via logistic regression. RESULTS: There were 98 patients with at least one positive RASS score, with median total duration of agitation 8 h (interquartile range [IQR] 4-18), and median duration of substantially fluctuating consciousness 2 days (IQR 1-3). Unfavorable 3-month outcome was significantly associated with a longer duration of fluctuating consciousness (odds ratio [OR] per day, 1.51; 95% confidence interval [CI], 1.04-2.20; p = 0.031), but a briefer duration of agitation (OR per hour, 0.94; 95% CI, 0.89-0.99; p = 0.031). CONCLUSION: Though a longer duration of fluctuating consciousness was associated with worse outcomes in our cohort, total duration of agitation was not, and may have had the opposite effect. Our findings should therefore challenge the intensity with which agitation is often treated in SAHpatients.
Authors: Melissa J Azur; Elizabeth A Stuart; Constantine Frangakis; Philip J Leaf Journal: Int J Methods Psychiatr Res Date: 2011-03 Impact factor: 4.035
Authors: E Sander Connolly; Alejandro A Rabinstein; J Ricardo Carhuapoma; Colin P Derdeyn; Jacques Dion; Randall T Higashida; Brian L Hoh; Catherine J Kirkness; Andrew M Naidech; Christopher S Ogilvy; Aman B Patel; B Gregory Thompson; Paul Vespa Journal: Stroke Date: 2012-05-03 Impact factor: 7.914
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Louis A Gomez; Qi Shen; Kevin Doyle; Athina Vrosgou; Angela Velazquez; Murad Megjhani; Shivani Ghoshal; David Roh; Sachin Agarwal; Soojin Park; Jan Claassen; Samantha Kleinberg Journal: Neurocrit Care Date: 2022-09-15 Impact factor: 3.532
Authors: David Robinson; Stephanie Thompson; Andrew Bauerschmidt; Kara Melmed; Caroline Couch; Soojin Park; Sachin Agarwal; David Roh; E Sander Connolly; Jan Claassen Journal: Neurocrit Care Date: 2019-06 Impact factor: 3.210