Ruth Tangonan1, Ronald Alvarado-Dyer1, Andrea Loggini2,3, Faten El Ammar1, Ruchit Kumbhani1, Christos Lazaridis1,4, Christopher Kramer1,4, Fernando D Goldenberg1,4, Ali Mansour5,6. 1. Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637-1470, USA. 2. Southern Illinois Healthcare, Carbondale, IL, USA. 3. Southern Illinois University, Springfield, IL, USA. 4. Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. 5. Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637-1470, USA. ali.mansour@uchospitals.edu. 6. Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. ali.mansour@uchospitals.edu.
Abstract
BACKGROUND: Unplanned readmission to the neurological intensive care unit (ICU) is an underinvestigated topic in patients admitted after spontaneous intracerebral hemorrhage (ICH). The purpose of this study is to investigate the frequency, clinical risk factors, and outcome of bounce back to the neurological ICU in a cohort of patients admitted after ICH. METHODS: This is a retrospective observational study inspecting bounce back to the neurological ICU in patients admitted with spontaneous ICH over an 8-year period. For each patient, demographics, medical history, clinical presentation, length of ICU stay, unplanned readmission to neurological ICU, cause of readmission, and mortality were reviewed. Bounce back to the neurological ICU was defined as an unplanned readmission to the neurological ICU from a general floor service during the same hospitalization. A multivariable analysis was used to define independent variables associated with bounce back to the neurological ICU as well as association between bounce back to the neurological ICU and mortality. The significance level was set at p < 0.05. RESULTS: A total of 221 patients were included. Among those, 20 (9%) had a bounce back to the neurological ICU. Respiratory complications (n = 11) was the most common reason for bounce back to the neurological ICU, followed by neurological (n = 5) and cardiological (n = 4) complications. In a multivariable logistic regression, location of hemorrhage in the basal ganglia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0-8.9, p = 0.03) and dysphagia at the time of transfer (OR: 3.9, 95% CI: 1.0-15.4, p = 0.04) were significantly associated with bounce back to the neurological ICU. After we controlled for ICH score, readmission to the ICU was also independently associated with higher mortality (OR: 14.1, 95% CI: 2.8-71.7, p < 0.01). CONCLUSIONS: Bounce back to the neurological ICU is not an infrequent complication in patients with spontaneous ICH and is associated with higher hospital length of stay and mortality. We identified relevant and potentially modifiable risk factors associated with bounce back to the neurological ICU. Future prospective studies are necessary to develop patient-centered strategies that may improve transition from the neurological ICU to the general floor.
BACKGROUND: Unplanned readmission to the neurological intensive care unit (ICU) is an underinvestigated topic in patients admitted after spontaneous intracerebral hemorrhage (ICH). The purpose of this study is to investigate the frequency, clinical risk factors, and outcome of bounce back to the neurological ICU in a cohort of patients admitted after ICH. METHODS: This is a retrospective observational study inspecting bounce back to the neurological ICU in patients admitted with spontaneous ICH over an 8-year period. For each patient, demographics, medical history, clinical presentation, length of ICU stay, unplanned readmission to neurological ICU, cause of readmission, and mortality were reviewed. Bounce back to the neurological ICU was defined as an unplanned readmission to the neurological ICU from a general floor service during the same hospitalization. A multivariable analysis was used to define independent variables associated with bounce back to the neurological ICU as well as association between bounce back to the neurological ICU and mortality. The significance level was set at p < 0.05. RESULTS: A total of 221 patients were included. Among those, 20 (9%) had a bounce back to the neurological ICU. Respiratory complications (n = 11) was the most common reason for bounce back to the neurological ICU, followed by neurological (n = 5) and cardiological (n = 4) complications. In a multivariable logistic regression, location of hemorrhage in the basal ganglia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0-8.9, p = 0.03) and dysphagia at the time of transfer (OR: 3.9, 95% CI: 1.0-15.4, p = 0.04) were significantly associated with bounce back to the neurological ICU. After we controlled for ICH score, readmission to the ICU was also independently associated with higher mortality (OR: 14.1, 95% CI: 2.8-71.7, p < 0.01). CONCLUSIONS: Bounce back to the neurological ICU is not an infrequent complication in patients with spontaneous ICH and is associated with higher hospital length of stay and mortality. We identified relevant and potentially modifiable risk factors associated with bounce back to the neurological ICU. Future prospective studies are necessary to develop patient-centered strategies that may improve transition from the neurological ICU to the general floor.
Authors: David Chiu; Leif Peterson; Mitchell S V Elkind; Jonathan Rosand; Linda M Gerber; Marc D Silverstein Journal: J Stroke Cerebrovasc Dis Date: 2010-05 Impact factor: 2.136
Authors: Ali Mansour; Andrea Loggini; Faten El Ammar; Daniel Ginat; Issam A Awad; Christos Lazaridis; Christopher Kramer; Valentina Vasenina; Sean P Polster; Anna Huang; Henry Olivera Perez; Paramita Das; Peleg M Horowitz; Tanya Zakrison; David Hampton; Selwyn O Rogers; Fernando D Goldenberg Journal: Neurocrit Care Date: 2020-10-06 Impact factor: 3.532