Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor

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Abstract

Introduction: The objective of this study was to compare long-term neurological outcomes in lowrisk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor. Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E. Results: We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months. Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalWestern Journal of Emergency Medicine
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2015

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Traumatic Intracranial Hemorrhage
Intensive Care Units
Glasgow Outcome Scale
Trauma Centers
Craniocerebral Trauma
Brain Injuries
Registries

Keywords

  • Brain injuries
  • Glasgow outcome scale
  • Intensive care units

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{55a75ce48f434856a467f080b0622dce,
title = "Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor",
abstract = "Introduction: The objective of this study was to compare long-term neurological outcomes in lowrisk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor. Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E. Results: We identified 151 patients; 45 (30{\%}) were admitted to the floor and 106 (70{\%}) to the ICU. Twenty-three (51{\%}; 95{\%} CI [36-66{\%}]) patients admitted to the floor and 55 (52{\%}; 95{\%} CI [42-62{\%}]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95{\%} CI [0.36-1.64]) for a normal GOS-E at six months. Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.",
keywords = "Brain injuries, Glasgow outcome scale, Intensive care units",
author = "Daniel Nishijima and Joy Melnikow and Tancredi, {Daniel J} and Kiarash Shahlaie and Utter, {Garth H} and Galante, {Joseph M} and Nancy Rudisill and {Holmes Jr}, {James F}",
year = "2015",
month = "3",
day = "1",
doi = "10.5811/westjem.2015.1.23356",
language = "English (US)",
volume = "16",
pages = "284--290",
journal = "Western Journal of Emergency Medicine",
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T1 - Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor

AU - Nishijima, Daniel

AU - Melnikow, Joy

AU - Tancredi, Daniel J

AU - Shahlaie, Kiarash

AU - Utter, Garth H

AU - Galante, Joseph M

AU - Rudisill, Nancy

AU - Holmes Jr, James F

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Introduction: The objective of this study was to compare long-term neurological outcomes in lowrisk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor. Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E. Results: We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months. Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

AB - Introduction: The objective of this study was to compare long-term neurological outcomes in lowrisk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor. Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E. Results: We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months. Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

KW - Brain injuries

KW - Glasgow outcome scale

KW - Intensive care units

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