Isolated Traumatic Subarachnoid Hemorrhage: An Evaluation of Critical Care Unit Admission Practices and Outcomes From a North American Perspective

Christopher D. Witiw; James P. Byrne; Farshad Nassiri; Jetan H. Badhiwala; Avery B. Nathens; Leodante da Costa

doi:10.1097/ccm.0000000000002931

December 23, 2017Critical Care Medicine

Isolated Traumatic Subarachnoid Hemorrhage: An Evaluation of Critical Care Unit Admission Practices and Outcomes From a North American Perspective

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Key Points

To evaluate the association between hospital-level ICU admission practices and clinically important outcomes among patients presenting with isolated traumatic subarachnoid hemorrhage and mild traumatic brain injury.
Multicenter observational cohort study of 14,146 patients aged 16 and older with isolated traumatic subarachnoid hemorrhage and Glasgow Coma Scale score ≥ 13 across 215 North American trauma centers.
Assessed primary outcome of neurosurgical intervention (intracranial monitor/drain, craniectomy, or craniotomy) alongside secondary outcomes of in-hospital mortality, discharge disposition, and length of stay.
Overall, 44.6% of patients were admitted to the ICU, whereas neurosurgical intervention occurred in only 0.24% of cases, with marked practice variation across centers (median odds ratio, 4.1).
Hospitals with the highest ICU admission rates showed no significant differences in neurosurgical intervention, in-hospital mortality, or discharge home compared with the lowest-admitting hospitals.
Patients treated at the highest-admitting hospitals experienced a longer hospital length of stay (ratio, 1.13; 95% CI, 1.07–1.20; p < 0.001) than those at the lowest-admitting hospitals.

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Implication

Multicenter cohort study reveals frequent ICU admissions despite rare neurosurgical needs in mild traumatic brain injury, suggesting an opportunity to safely optimize hospital resources.

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Witiw et al. (2017) studied this question.

synapsesocial.com/papers/6a7d8fbee0b3e71359cb49d3 https://doi.org/10.1097/ccm.0000000000002931

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Isolated Traumatic Subarachnoid Hemorrhage: An Evaluation of Critical Care Unit Admission Practices and Outcomes From a North American Perspective

Key Points

No abstract yet

Implication

Discussion

Cite This Study

Isolated Traumatic Subarachnoid Hemorrhage: An Evaluation of Critical Care Unit Admission Practices and Outcomes From a North American Perspective

Key Points

No abstract yet

Implication

Discussion

Cite This Study

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