Abstract
Admitting facility may significantly affect outcome for spontaneous subarachnoid hemorrhage patients. We assessed outcomes of patients admitted directly to a comprehensive stroke center with those initially admitted to a general hospital and subsequently transferred. The comprehensive stroke center included a neurocritical care ICU, cerebrovascular neurosurgeons and endovascular specialists. Methods: We identified 107 consecutive spontaneous subarachnoid hemorrhage cases. Of these cases, 31 (29%) patients were admitted directly and 76 (71%) were transferred from general hospitals. Univariate and multivariate analyses evaluated differences in mortality, complications, discharge disposition, and in-hospital length of stay. Results: Differences in baseline parameters (age, gender, admission Glasgow Coma Scale, Fisher grade, admission Hunt and Hess grade) were not statistically significant between direct-admit and transfer patients at our institution. Transferred patients developed vasospasm more frequently (58% vs. 32%; P<0·05) and had a longer delay time to surgery (3·9-days vs. 2·4-days: P<0·05). Multivariate analysis showed that the likelihood of vasospasm was significantly higher for transfer patients (OR 3·46, CI: 1·2-10·3, P=0·03). In addition, longer in-hospital stays and higher odds of non-routine discharge were observed in transferred patients (P<0·01). No differences in outcome could be identified for surgical vs. endovascular treatment rates between direct-admit and transfer patients. An association, but no causative link, can be made between the effect of transfer and the outcomes of SAH patients due to the retrospective nature of our study. Conclusions: Spontaneous subarachnoid hemorrhage patients admitted directly to our comprehensive stroke center showed less complications compared to those transferred from general hospitals. This improvement was independent of time to treatment. Additional research in multiple centers using prospective analysis should be conducted to confirm that preferential direct transport to a comprehensive stroke center would likely yield considerable improvements in public health.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 529-533 |
| Number of pages | 5 |
| Journal | International Journal of Stroke |
| Volume | 10 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jun 1 2015 |
| Externally published | Yes |
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Keywords
- Admitting facility
- Comprehensive stroke center
- Neurovascular center
- Subarachnoid hemorrhage
- Tertiary care center
- Vasospasm
ASJC Scopus subject areas
- Neurology
Cite this
Type of admission is associated with outcome of spontaneous subarachnoid hemorrhage. / Drazin, Doniel; Rosner, Jack; Nuno, Miriam A; Alexander, Michael J.; Schievink, Wouter I.; Palestrant, David; Lyden, Patrick D.; Miller, Chad.
In: International Journal of Stroke, Vol. 10, No. 4, 01.06.2015, p. 529-533.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Type of admission is associated with outcome of spontaneous subarachnoid hemorrhage
AU - Drazin, Doniel
AU - Rosner, Jack
AU - Nuno, Miriam A
AU - Alexander, Michael J.
AU - Schievink, Wouter I.
AU - Palestrant, David
AU - Lyden, Patrick D.
AU - Miller, Chad
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Admitting facility may significantly affect outcome for spontaneous subarachnoid hemorrhage patients. We assessed outcomes of patients admitted directly to a comprehensive stroke center with those initially admitted to a general hospital and subsequently transferred. The comprehensive stroke center included a neurocritical care ICU, cerebrovascular neurosurgeons and endovascular specialists. Methods: We identified 107 consecutive spontaneous subarachnoid hemorrhage cases. Of these cases, 31 (29%) patients were admitted directly and 76 (71%) were transferred from general hospitals. Univariate and multivariate analyses evaluated differences in mortality, complications, discharge disposition, and in-hospital length of stay. Results: Differences in baseline parameters (age, gender, admission Glasgow Coma Scale, Fisher grade, admission Hunt and Hess grade) were not statistically significant between direct-admit and transfer patients at our institution. Transferred patients developed vasospasm more frequently (58% vs. 32%; P<0·05) and had a longer delay time to surgery (3·9-days vs. 2·4-days: P<0·05). Multivariate analysis showed that the likelihood of vasospasm was significantly higher for transfer patients (OR 3·46, CI: 1·2-10·3, P=0·03). In addition, longer in-hospital stays and higher odds of non-routine discharge were observed in transferred patients (P<0·01). No differences in outcome could be identified for surgical vs. endovascular treatment rates between direct-admit and transfer patients. An association, but no causative link, can be made between the effect of transfer and the outcomes of SAH patients due to the retrospective nature of our study. Conclusions: Spontaneous subarachnoid hemorrhage patients admitted directly to our comprehensive stroke center showed less complications compared to those transferred from general hospitals. This improvement was independent of time to treatment. Additional research in multiple centers using prospective analysis should be conducted to confirm that preferential direct transport to a comprehensive stroke center would likely yield considerable improvements in public health.
AB - Admitting facility may significantly affect outcome for spontaneous subarachnoid hemorrhage patients. We assessed outcomes of patients admitted directly to a comprehensive stroke center with those initially admitted to a general hospital and subsequently transferred. The comprehensive stroke center included a neurocritical care ICU, cerebrovascular neurosurgeons and endovascular specialists. Methods: We identified 107 consecutive spontaneous subarachnoid hemorrhage cases. Of these cases, 31 (29%) patients were admitted directly and 76 (71%) were transferred from general hospitals. Univariate and multivariate analyses evaluated differences in mortality, complications, discharge disposition, and in-hospital length of stay. Results: Differences in baseline parameters (age, gender, admission Glasgow Coma Scale, Fisher grade, admission Hunt and Hess grade) were not statistically significant between direct-admit and transfer patients at our institution. Transferred patients developed vasospasm more frequently (58% vs. 32%; P<0·05) and had a longer delay time to surgery (3·9-days vs. 2·4-days: P<0·05). Multivariate analysis showed that the likelihood of vasospasm was significantly higher for transfer patients (OR 3·46, CI: 1·2-10·3, P=0·03). In addition, longer in-hospital stays and higher odds of non-routine discharge were observed in transferred patients (P<0·01). No differences in outcome could be identified for surgical vs. endovascular treatment rates between direct-admit and transfer patients. An association, but no causative link, can be made between the effect of transfer and the outcomes of SAH patients due to the retrospective nature of our study. Conclusions: Spontaneous subarachnoid hemorrhage patients admitted directly to our comprehensive stroke center showed less complications compared to those transferred from general hospitals. This improvement was independent of time to treatment. Additional research in multiple centers using prospective analysis should be conducted to confirm that preferential direct transport to a comprehensive stroke center would likely yield considerable improvements in public health.
KW - Admitting facility
KW - Comprehensive stroke center
KW - Neurovascular center
KW - Subarachnoid hemorrhage
KW - Tertiary care center
KW - Vasospasm
UR - http://www.scopus.com/inward/record.url?scp=84929328899&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84929328899&partnerID=8YFLogxK
U2 - 10.1111/ijs.12005
DO - 10.1111/ijs.12005
M3 - Article
C2 - 23489935
AN - SCOPUS:84929328899
VL - 10
SP - 529
EP - 533
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
IS - 4
ER -