Quincy K Tran1,2, Sagar Dave3, Daniel J Haase1,2, Laura Tiffany1, Shannon Gaasch2, Wan-Tsu W Chang1,2, Kevin Jones1,2, Matthew J Kole4, Aaron Wessell4, Gary Schwartzbauer2,4, Thomas M Scalea2,5, Jay Menaker2,5. 1. University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland. 2. University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland. 3. University of Maryland Medical Center, Department of Surgical Critical Care, Baltimore, Maryland. 4. University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland. 5. University of Maryland School of Medicine, Department of Surgery, Baltimore, Maryland.
Abstract
INTRODUCTION: Patients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. At our academic referral center, the neurocritical care unit (NCCU) receives patients directly from referring facilities. However, when no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). We hypothesized that the CCRU expedites transfer of sICH patients and facilitates timely external ventricular drain (EVD) placement comparable to the NCCU. METHODS: This is a pre-post study of adult patients transferred with sICH and EVD placement. Patients admitted between January 2011-July 2013 (2011 Control) were compared with patients admitted either to the CCRU or the NCCU (2013 Control) between August 2013-September 2015. The primary outcome was time interval from arrival at any intensive care units (ICU) to time of EVD placement (ARR-EVD). Secondary outcomes included time interval from emergency department transfer request to arrival, and in-hospital mortality. We assessed clinical association by multivariable logistic regressions. RESULTS: We analyzed 259 sICH patients who received EVDs: 123 (48%) CCRU; 81 (31%) 2011 Control; and 55 (21%) in the 2013 Control. The groups had similar characteristics, age, disease severity, and mortality. Median ARR-EVD time was 170 minutes [106-311] for CCRU patients; 241 minutes [152-490] (p < 0.01) for 2011 Control; and 210 minutes [139-574], p = 0.28) for 2013 Control. Median transfer request-arrival time for CCRU patients was significantly less than both control groups. Multivariable logistic regression showed each minute delay in ARR-EVD was associated with 0.03% increased likelihood of death (odds ratio 1.0003, 95% confidence interval, 1.0001-1.006, p = 0.043). CONCLUSION: Patients admitted to the CCRU had shorter transfer times when compared to patients admitted directly to other ICUs. Compared to the specialty NCCU, the CCRU had similar time interval from arrival to EVD placement. A resuscitation unit like the CCRU can complement the specialty unit NCCU in caring for patients with sICH who require EVDs.
INTRODUCTION: Patients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. At our academic referral center, the neurocritical care unit (NCCU) receives patients directly from referring facilities. However, when no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). We hypothesized that the CCRU expedites transfer of sICH patients and facilitates timely external ventricular drain (EVD) placement comparable to the NCCU. METHODS: This is a pre-post study of adult patients transferred with sICH and EVD placement. Patients admitted between January 2011-July 2013 (2011 Control) were compared with patients admitted either to the CCRU or the NCCU (2013 Control) between August 2013-September 2015. The primary outcome was time interval from arrival at any intensive care units (ICU) to time of EVD placement (ARR-EVD). Secondary outcomes included time interval from emergency department transfer request to arrival, and in-hospital mortality. We assessed clinical association by multivariable logistic regressions. RESULTS: We analyzed 259 sICH patients who received EVDs: 123 (48%) CCRU; 81 (31%) 2011 Control; and 55 (21%) in the 2013 Control. The groups had similar characteristics, age, disease severity, and mortality. Median ARR-EVD time was 170 minutes [106-311] for CCRU patients; 241 minutes [152-490] (p < 0.01) for 2011 Control; and 210 minutes [139-574], p = 0.28) for 2013 Control. Median transfer request-arrival time for CCRU patients was significantly less than both control groups. Multivariable logistic regression showed each minute delay in ARR-EVD was associated with 0.03% increased likelihood of death (odds ratio 1.0003, 95% confidence interval, 1.0001-1.006, p = 0.043). CONCLUSION: Patients admitted to the CCRU had shorter transfer times when compared to patients admitted directly to other ICUs. Compared to the specialty NCCU, the CCRU had similar time interval from arrival to EVD placement. A resuscitation unit like the CCRU can complement the specialty unit NCCU in caring for patients with sICH who require EVDs.
Authors: Brendan P Lovasik; D Jay McCracken; Courtney E McCracken; Margaret E McDougal; Jason M Frerich; Owen B Samuels; Gustavo Pradilla Journal: World Neurosurg Date: 2016-07-17 Impact factor: 2.104
Authors: Quincy K Tran; James O'Connor; Roumen Vesselinov; Daniel Haase; Rebecca Duncan; Ashley Aitken; Jeffrey H Rea; Kevin Jones; Theresa Dinardo; Thomas Scalea; Jay Menaker; Lewis Rubinson Journal: J Emerg Med Date: 2019-11-22 Impact factor: 1.484
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Authors: Christopher M Holland; Brendan P Lovasik; Brian M Howard; Evan W McClure; Owen B Samuels; Daniel L Barrow Journal: Neurosurgery Date: 2017-09-01 Impact factor: 4.654
Authors: Fred Rincon; Stephan A Mayer; Juan Rivolta; Joshua Stillman; Bernadette Boden-Albala; Mitchell S V Elkind; Randolph Marshall; Ji Y Chong Journal: Neurocrit Care Date: 2010-08 Impact factor: 3.210
Authors: Daniel B Herrick; Natalie Ullman; Saman Nekoovaght-Tak; Daniel F Hanley; Issam Awad; Shannon LeDroux; Carol B Thompson; Wendy C Ziai Journal: Neurocrit Care Date: 2014-12 Impact factor: 3.210
Authors: Kyle J Gunnerson; Benjamin S Bassin; Renee A Havey; Nathan L Haas; Cemal B Sozener; Richard P Medlin; Jennifer A Gegenheimer-Holmes; Stephanie L Laurinec; Caryn Boyd; James A Cranford; Sage P Whitmore; Cindy H Hsu; Reham Khan; Neha N Vazirani; Stephen G Maxwell; Robert W Neumar Journal: JAMA Netw Open Date: 2019-07-03
Authors: Elizabeth Powell; Iana Sahadzic; Daniel Najafali; Emilie Berman; Katie Andersen; Leenah Z Afridi; Zoe Gasparotti; Erin Niles; Jeffrey Rea; Thomas Scalea; Daniel J Haase; Quincy K Tran Journal: Crit Care Res Pract Date: 2022-07-19