Medical complications drive length of stay after brain hemorrhage: A cohort study

Andrew M Naidech, Bernard R. Bendok, Paul C Tamul, Sarice L. Bassin, Charles M. Watts, H. Hunt Batjer, Thomas P Bleck

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Introduction: Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted patients. Methods: We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement, and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU and hospital LOS). Results: Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection, fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients with ICH the volume of the initial bleed was significant in some models. Conclusion: LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary to eliminate "preventable" complications and minimize LOS after brain hemorrhage.

Original languageEnglish (US)
Pages (from-to)11-19
Number of pages9
JournalNeurocritical Care
Volume10
Issue number1
DOIs
StatePublished - Feb 1 2009

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Intracranial Hemorrhages
Length of Stay
Cohort Studies
Pharmacists
Hand Hygiene
Nervous System Trauma
Glasgow Coma Scale
Acute Lung Injury
Medical Staff
Cerebral Hemorrhage
Mechanical Ventilators
Critical Care
Nonparametric Statistics
Linear Models
Analysis of Variance
Fever
Insulin
Costs and Cost Analysis
Glucose

Keywords

  • Acute lung injury
  • Bacteremia
  • Intracerebral hemorrhage
  • Length of stay
  • Outcomes
  • Pneumonia
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Naidech, Andrew M ; Bendok, Bernard R. ; Tamul, Paul C ; Bassin, Sarice L. ; Watts, Charles M. ; Batjer, H. Hunt ; Bleck, Thomas P. / Medical complications drive length of stay after brain hemorrhage : A cohort study. In: Neurocritical Care. 2009 ; Vol. 10, No. 1. pp. 11-19.
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Medical complications drive length of stay after brain hemorrhage : A cohort study. / Naidech, Andrew M; Bendok, Bernard R.; Tamul, Paul C; Bassin, Sarice L.; Watts, Charles M.; Batjer, H. Hunt; Bleck, Thomas P.

In: Neurocritical Care, Vol. 10, No. 1, 01.02.2009, p. 11-19.

Research output: Contribution to journalArticle

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T1 - Medical complications drive length of stay after brain hemorrhage

T2 - A cohort study

AU - Naidech, Andrew M

AU - Bendok, Bernard R.

AU - Tamul, Paul C

AU - Bassin, Sarice L.

AU - Watts, Charles M.

AU - Batjer, H. Hunt

AU - Bleck, Thomas P

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N2 - Introduction: Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted patients. Methods: We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement, and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU and hospital LOS). Results: Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection, fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients with ICH the volume of the initial bleed was significant in some models. Conclusion: LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary to eliminate "preventable" complications and minimize LOS after brain hemorrhage.

AB - Introduction: Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted patients. Methods: We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement, and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU and hospital LOS). Results: Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection, fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients with ICH the volume of the initial bleed was significant in some models. Conclusion: LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary to eliminate "preventable" complications and minimize LOS after brain hemorrhage.

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KW - Bacteremia

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KW - Pneumonia

KW - Subarachnoid hemorrhage

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