Early predictors of prolonged stay in a critical care unit following aneurysmal subarachnoid hemorrhage.

Abstract

BACKGROUND:

Aneurysmal subarachnoid hemorrhage (aSAH) is a neurologic emergency that typically warrants initial monitoring in a critical care setting. The aim of this study is to identify clinical and radiologic features on admission that predict a protracted critical care admission following aSAH.

METHODS:

Exploratory posthoc analysis was performed on the 413 patients enrolled in Clazosentan to Overcome Neurological iSChemia and Infarction OccUrring after Subarachnoid hemorrhage (CONSCIOUS-1), a prospective randomized control trial of clazosentan for the prevention of vasospasm after aSAH. The association between potential clinical and radiographic covariates, and the length of stay (LOS) in a critical care unit after aSAH was determined using a Cox proportional hazards model. Covariates with a significance level of p < 0.20, on univariate analysis, were entered into a multivariate forward conditional analysis to identify independent predictors of prolonged LOS.

RESULTS:

The mean LOS was 12.6 ± 10.6 days. On multivariate analysis, age (hazard ratio [HR] 1.01, 95 % confidence interval [CI] 1.00-1.02; p = 0.032), a history of hypertension (HR 1.30, CI 1.01-1.67; p = 0.045), and a World Federation of Neurosurgical Societies Score of IV-V on admission (HR 1.38, CI 1.05-1.81; p = 0.02) were the clinical features associated with a greater critical care LOS following aSAH. Intracerebral hemorrhage (HR 1.50, CI 1.03-2.21; p = 0.004) and increasing intraventricular clot burden (HR 1.08, CI 1.03-1.14; p = 0.037) on admission computed tomography were the radiologic features associated with prolonged LOS.

CONCLUSIONS:

We have identified several early risk factors associated with a prolonged critical care stay following aSAH.

• Authors: Christopher D Witiw, George M Ibrahim, Aria Fallah, R Loch Macdonald
• Journal: Neurocritical care (Neurocrit Care) Vol. 18 Issue 3 Pg. 291-7 (Jun 2013) ISSN: 1556-0961 [Electronic] United States
• PMID: 23371849 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dioxanes
• Endothelin A Receptor Antagonists
• Pyridines
• Pyrimidines
• Sulfonamides
• Tetrazoles
• clazosentan

Topics

• Adult
• Age Factors
• Aneurysm, Ruptured (complications, epidemiology)
• Brain (diagnostic imaging)
• Cerebral Ventricles
• Dioxanes (therapeutic use)
• Endothelin A Receptor Antagonists
• Female
• Humans
• Hypertension (complications)
• Intensive Care Units (statistics & numerical data)
• Intracranial Aneurysm (complications, epidemiology)
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Prospective Studies
• Pyridines (therapeutic use)
• Pyrimidines (therapeutic use)
• Risk Factors
• Severity of Illness Index
• Subarachnoid Hemorrhage (diagnostic imaging, epidemiology, etiology)
• Sulfonamides (therapeutic use)
• Tetrazoles (therapeutic use)
• Tomography, X-Ray Computed
• Vasospasm, Intracranial (etiology, prevention & control)