Withdrawal of Life-Sustaining Treatment Mediates Mortality in Patients With Intracerebral Hemorrhage With Impaired Consciousness

Stroke ◽  
2021 ◽  
Author(s):  
Ayham Alkhachroum ◽  
Antonio J. Bustillo ◽  
Negar Asdaghi ◽  
Erika Marulanda-Londono ◽  
Carolina M. Gutierrez ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Mediation Effect ◽  
Hospital Length Of Stay ◽  
Do Not Resuscitate ◽  
Hospital Size ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Life Sustaining Treatment

Background and Purpose: Impaired level of consciousness (LOC) on presentation at hospital admission in patients with intracerebral hemorrhage (ICH) may affect outcomes and the decision to withhold or withdraw life-sustaining treatment (WOLST). Methods: Patients with ICH were included across 121 Florida hospitals participating in the Florida Stroke Registry from 2010 to 2019. We studied the effect of LOC on presentation on in-hospital mortality (primary outcome), WOLST, ambulation status on discharge, hospital length of stay, and discharge disposition. Results: Among 37 613 cases with ICH (mean age 71, 46% women, 61% White, 20% Black, 15% Hispanic), 12 272 (33%) had impaired LOC at onset. Compared with cases with preserved LOC, patients with impaired LOC were older (72 versus 70 years), more women (49% versus 45%), more likely to have aphasia (38% versus 16%), had greater ICH score (3 versus 1), greater risk of WOLST (41% versus 18%), and had an increased in-hospital mortality (32% versus 12%). In the multivariable-logistic regression with generalized estimating equations accounting for basic demographics, comorbidities, ICH severity, hospital size and teaching status, impaired LOC was associated with greater mortality (odds ratio, 3.7 [95% CI, 3.1–4.3], P <0.0001) and less likely discharged home or to rehab (odds ratio, 0.3 [95% CI, 0.3–0.4], P <0.0001). WOLST significantly mediated the effect of impaired LOC on mortality (mediation effect, 190 [95% CI, 152–229], P <0.0001). Early WOLST (<2 days) occurred among 51% of patients. A reduction in early WOLST was observed in patients with impaired LOC after the 2015 American Heart Association/American Stroke Association ICH guidelines recommending aggressive treatment and against early do-not-resuscitate. Conclusions: In this large multicenter stroke registry, a third of ICH cases presented with impaired LOC. Impaired LOC was associated with greater in-hospital mortality and worse disposition at discharge, largely influenced by early decision to withhold or WOLST.

Abstract P877: Race-Ethnic Disparities in Intracerebral Hemorrhage Outcomes

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Antonio Bustillo ◽  
zakariya hassouneh ◽  
Kefeng Wang ◽  
Hannah Gardener ◽  
Carolina M Gutierrez ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Ethnic Disparities ◽  
Logistic Models ◽  
Chi Square ◽  
Hospital Size ◽  
Lower Odds ◽  
Stroke Registry ◽  
Race Ethnicity ◽  
Ich Score

Introduction: Prior literature has reported differences in outcomes following stroke by race/ethnicity. While more attention has been focused on ischemic stroke, we sought to identify race/ethnic disparities in hospital outcomes at discharge following intracerebral hemorrhage (ICH). Methods: Data were obtained from the Florida Stroke Registry (FSR) consisting of stroke centers utilizing the Get With the Guidelines-Stroke (GWTG-S) tool. Pearson Chi-square and Kruskall-Wallis tests were used to compare descriptive statistics by race/ethnicity on 26,113 Florida cases with ICH discharged 2010-2018. Outcomes at discharge included in-hospital mortality, disposition, ambulation, modified Rankin Scale score & timing of initiation of comfort measures only (CMO). Generalized estimating equations logistic models accounted for age, sex, insurance, smoking, hypertension, diabetes, dyslipidemia, prior anti-coagulant/platelet use, history of stroke/TIA, admission NIHSS, ICH score, arrival mode, hospital size, teaching status & years in GWTG-S. Results: 65% were non-Hispanic White (NHW), 20% non-Hispanic Black (NHB) and 15% Hispanic. NHB were younger at ICH onset (median 60, IQR 52-71; NHW: 71, 58-81; Hispanic: 69, 52-80; p < 0.0001), had higher risk of hypertension (HTN; 74%; NHW: 66%; Hispanic: 64%; p < 0.0001), diabetes (29%; NHW: 20%; Hispanic: 27%; p < 0.0001), smoking (14%; NHW: 12%; Hispanic: 9%; p < 0.0001) and chronic renal insufficiency (8%; NHW: 4%; Hispanic: 4% ; p < 0.0001). NHW had higher risk of dyslipidemia (35%; NHB: 21%; Hispanic: 27%; p < 0.0001), atrial fibrillation/flutter (20%; NHB: 6%; Hispanic: 10%; p < 0.0001) and a higher use of prior anticoagulants (13%; NHB: 6%, Hispanic: 8%, p < 0.0001). NHB had lower odds of in-hospital mortality (adjusted OR=0.77, 95% CI=[0.61-0.96]) and CMO on days 0/1 (0.63, 0.45-0.87) compared to NHW. Conclusions: Differences in risk factor profiles, such as higher rates of HTN in NHB and greater use of anticoagulants among NHW, raises the possibility of tailoring preventive and acute care responses to ICH by race/ethnicity. Moreover, despite observing persistently lower odds of mortality and CMO among NHB after adjustment, more data are needed to identify the unobserved effects leading to these disparities.

Abstract P436: Outcomes in Intracerebral Hemorrhage Patients Presenting With Impaired Level of Consciousness

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ayham Alkhachroum ◽  
Antonio Bustillo ◽  
Negar Asdaghi ◽  
Erika T Marulanda-londono ◽  
Carolina M Gutierrez ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Early Recovery ◽  
Hospital Size ◽  
Stroke Registry ◽  
Level Of Consciousness ◽  
Chi Squared ◽  
Ich Score ◽  
Gcs Score

Background: Impaired level of consciousness (LOC) on presentation after intracerebral hemorrhage (ICH) may affect outcomes and the decision to withdraw life-sustaining treatment (WLST). We aim to investigate the outcomes and trends after ICH by the LOC status on presentation. Methods: We studied 37,613 cases with ICH in the Florida Stroke Registry from 2010-2019. Pearson chi-squared and Kruskall-Wallis tests were used to compare descriptive statistics. A multivariable-logistic regression with GEE accounted for basic demographics, comorbidities, ICH severity, hospital size and teaching status. Results: At stroke presentation, 12,272 (33%) cases had impaired LOC (mean age 72, 49% women, 61 white%, 20% Black, 14% Hispanic). Compared to cases with preserved LOC, LOC case were older (72 vs. 70 years old), more women (49% vs. 45%), more likely to have aphasia (38% vs. 16%), had lower GCS score (9 vs. 15), had greater ICH score (3 vs. 1), greater WLST rates (41% vs. 18%), and had greater in-hospital mortality rates (32% vs. 12%). In our adjusted model, no association was found between impaired LOC and in-hospital mortality, or length of stay. Those with preserved LOC were more likely discharged home/rehab (OR 0.4, 95%CI 0.2-0.9, p=0.03) and more likely to ambulate independently (OR 1.6, 95%CI 1.1-2.4, p=0.02). Trend analysis (2010-2019) showed decreased mortality, increased length of stay, and increased rates of discharge to home/rehab in all, regardless of the LOC status. Conclusion: In this large multi-center registry, a third of ICH cases presents with impaired LOC. Although LOC was not associated with significantly more in-hospital morality, LOC was associated with had higher rates of WLST and more disability at discharge. Future efforts should focus on biomarkers of LOC that detect early recovery and reduced disability in ICH patients with impaired LOC.

scholarly journals Outcomes of Neutropenic Patients with Clostridium difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s339-s340
Author(s):  
Roopali Sharma ◽  
Deepali Dixit ◽  
Sherin Pathickal ◽  
Jenny Park ◽  
Bernice Lee ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Treatment Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
End Point ◽  
Neutropenic Patients

Background: Data from Clostridium difficile infection (CDI) in neutropenic patients are still scarce. Objective: To assess outcomes of CDI in patients with and without neutropenia. Methods: The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results: Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P = .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P < .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P = .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions: Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding: NoneDisclosures: None

Lack of Association between Preoperative Statin Use and Respiratory and Neurologic Complications after Cardiac Surgery

2017 ◽  
Vol 126 (5) ◽  
pp. 799-809 ◽  
Author(s):  
Ryu Komatsu ◽  
Huseyin Oguz Yilmaz ◽  
Jing You ◽  
C. Allen Bashour ◽  
Shobana Rajan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Odds Ratio ◽  
Hospital Length Of Stay ◽  
Neurologic Complications ◽  
Prolonged Ventilation ◽  
Statin Use

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.

Abstract P44: Does Race Influence Disability and Hospital Disposition After Cerebral Hemorrhage? Results From a Community Wide Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Dilip K Pandey ◽  
Venkatesh Aiyagari
Keyword(s):  
Hospital Mortality ◽  
Racial Differences ◽  
The United States ◽  
Term Treatment ◽  
Severe Disability ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Long Term Treatment ◽  
Mortality Incidence

Background: Compared to Non-Hispanic whites (NHW), intracerebral hemorrhage (ICH) has a higher incidence among African Americans (AA) where it also occurs at a younger age. Previous studies have concluded that there are no racial differences in hospital mortality after ICH, but the influence of race on disability and discharge disposition after ICH has not been studied. Methods: The Illinois Capture-Stroke registry is a prospectively collected database of patients admitted with a stroke to 56 acute care hospitals in Illinois. We performed a retrospective analysis of the association between race, and in-hospital mortality, modified Rankin Scale (mRS) score at discharge and discharge disposition in 804 patients with ICH enrolled in the registry between 2005 and 2007. Results: We studied 530 NHW and 175 AA patients with radiologically proven ICH. Compared to NHW, AA patients were younger (mean age NHW: 73±14 vs AA: 58±12 yrs, p <0.001) and had a higher incidence of hypertension, smoking and coronary artery disease. Although there was no racial difference in hospital mortality, incidence of moderate to severe disability (mRS 4-5) was significantly higher in NHW (69%) compared to AA (55%). Among patients <65 years old, a trend (p=0.102) towards a higher disability in NHW was observed (60% in NHW vs. 45% in AA). In this age group, 41% of NHW and 33% of AA were discharged to rehabilitation facilities while 37% of NHW and 44% of AA were discharged home. Conclusion: A very large proportion of patients with ICH are discharged from hospitals with moderate or severe disability. Compared to NHW, a higher proportion of younger AA patients are discharged home after ICH. The long term outcomes of survivors after ICH in the United States is not well studied, and the influence of racial and socioeconomic factors on long-term treatment and outcome after ICH needs to be explored.

Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

2019 ◽  
Vol 11 (6) ◽  
pp. 579-583 ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Konark Malhotra ◽  
Aristeidis H Katsanos ◽  
Abhi Pandhi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Medical Management ◽  
Intervention Group ◽  
Stroke Severity ◽  
Hematoma Evacuation ◽  
Discharge Disposition ◽  
Relative Safety

BackgroundWe conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH).MethodsWe evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months.ResultsAmong 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25–51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm3 (IQR, 25–50) vs 15 cm3 (IQR, 5–20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041).ConclusionsMinimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.

scholarly journals Uric Acid and Clinical Outcomes Among Intracerebral Hemorrhage Patients: Results From the China Stroke Center Alliance

2020 ◽  
Vol 11 ◽  
Author(s):  
Xinmin Liu ◽  
Zhentang Cao ◽  
Hongqiu Gu ◽  
Kaixuan Yang ◽  
Ruijun Ji ◽  
...  
Keyword(s):  
Uric Acid ◽  
Gastrointestinal Bleeding ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Significant Evidence ◽  
Discharge Disposition ◽  
Stroke Center ◽  
Swallow Function

Background and Purpose: The effect of uric acid (UA) levels on severity and prognosis of spontaneous intracerebral hemorrhage (ICH) remains controversial. We aimed to explore the association of admission UA levels with stroke severity and outcomes in ICH patients.Materials and Methods: The patients enrolled in this study were from the China Stroke Center Alliance study (CSCA). Patients were divided into four groups (Q1–Q4) according to the quartiles of UA levels at admission. The primary outcome was in-hospital mortality. The secondary outcomes included stroke severity, in-hospital complications, and discharge disposition. Multivariate logistic regression was adopted to explore the association of UA levels with outcomes after ICH.Results: Patients (84,304) with acute ICH were included in the final analysis; the median (interquartile range) of UA was 277 (210, 354) μmol/L. The four groups were defined as follows: Q1 ≤ 210 μmol/L, 210 μmol/L &lt; Q2 ≤ 277 μmol/L, 277 μmol/L &lt; Q3 ≤ 354 μmol/L, Q4 &gt; 354 μmol/L. There was no significant evidence indicating that UA levels were correlated with the discharge disposition and in-hospital mortality after ICH. However, compared to Q1, the patients with higher UA levels had decreased odds of severe stroke (NIHSS ≥ 16) at admission (OR 0.89, 95% CI 0.86–0.92). An L-shaped association was found between UA and severe stroke. Among in-hospital complications, decrease in pneumonia, poor swallow function, gastrointestinal bleeding, and deep vein thrombosis (DVT) were significantly associated with higher UA levels compared to Q1 (P for trend &lt; 0.0001).Conclusions: UA was a protective factor for stroke severity and in-hospital complications such as pneumonia, poor swallow function, gastrointestinal bleeding, and DVT. However, no significant evidence indicated that UA levels were predictive of the discharge disposition and in-hospital mortality after ICH.

Abstract P397: Outcomes in Acute Ischemic Stroke Patients Presenting With Impaired Level of Consciousness

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ayham Alkhachroum ◽  
Antonio Bustillo ◽  
Negar Asdaghi ◽  
Erika T Marulanda-londono ◽  
Carolina M Gutierrez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Early Recovery ◽  
Hospital Size ◽  
Stroke Registry ◽  
Level Of Consciousness

Background: Impaired level of consciousness (LOC) on presentation after acute ischemic stroke (AIS) may affect outcomes and the decision to withdraw life-sustaining treatment (WLST). We aim to investigate the outcomes and their trends after AISby the LOC on stroke presentation. Methods: We studied 238,989 cases with AIS in the Florida Stroke Registry from 2010-2019. Pearson chi-squared and Kruskall-Wallis tests were used to compare descriptive statistics. A multivariable-logistic regression with GEE accounted for basic demographics, comorbidities, stroke severity, location, hospital size and teaching status. Results: At stroke presentation, 32,861 (14%) cases had impaired LOC (mean age 77, 54% women, 60 white%, 19% Black, 16% Hispanic). Compared to cases with preserved LOC, impaired cases were older (77 vs. 72 years old), more women (54% vs. 48%), had more comorbidities, greater stroke severity on NIHSS ≥ 5 (49% vs. 27%), higher WLST rates (3% vs. 0.6%), and greater in-hospital mortality rates (9% vs. 3%). In our adjusted model however, no significant association was found between impaired LOC and in-hospital mortality, or length of stay. Those with preserved LOC were more likely discharged home/rehab (OR 0.7, 95%CI 0.6-0.8, p<0.0001) and more likely to ambulate independently (OR 0.7, 95%CI 0.6-0.9, p=0.001). Trend analysis (2010-2019) showed decreased mortality, increased length of stay, and increased rates of discharge to home/rehab in all irrespective of LOC status. Conclusion: In this large multicenter registry, AIS cases presenting with impaired LOC had more severe strokes at presentation. Although LOC was not associated with significantly worse in-hospital morality, it was associated with higher rates of WLST and more disability among survivors. Future efforts should focus on biomarkers of LOC that discriminates the potential for early recovery and reduced disability in acute stroke patients with impaired LOC.

Seasonal variation in the management and outcomes of cardiac arrest complicating acute myocardial infarction

QJM ◽  
2021 ◽  
Author(s):  
S H Patlolla ◽  
A Kanwar ◽  
P R Sundaragiri ◽  
W Cheungpasitporn ◽  
R P Doshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Hospitalization Costs

Summary Background There are limited data on the influence of seasons on the outcomes of acute myocardial infarction-cardiac arrest (AMI-CA). Aim To evaluate the outcomes of AMI-CA by seasons in the United States Design Retrospective cohort study Methods Using the National Inpatient Sample from 2000 to 2017, adult (&gt;18 years) admissions with AMI-CA were identified. Seasons were defined by the month of admission as spring, summer, fall and winter. The outcomes of interest were prevalence of AMI-CA, in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), hospital length of stay, hospitalization costs and discharge disposition. Results Of the 10 880 856 AMI admissions, 546 334 (5.0%) were complicated by CA, with a higher prevalence in fall and winter (5.1% each) compared to summer (5.0%) and spring (4.9%). Baseline characteristics of AMI-CA admissions admitted in various seasons were largely similar. Compared to AMI-CA admissions in spring, summer and fall, AMI-CA admissions in winter had slightly lower rates of coronary angiography (63.3–64.3% vs. 61.4%) and PCI (47.2–48.4% vs. 45.6%). Compared to those admitted in the spring, adjusted in-hospital mortality was higher for winter {46.8% vs. 44.2%; odds ratio (OR) 1.08 [95% confidence interval (CI) 1.06–1.10]; P &lt; 0.001}, lower for summer [43% vs. 44.2%; OR 0.97 (95% CI 0.95–0.98); P &lt; 0.001] and comparable for fall [44.4% vs. 44.2%; OR 1.01 (95% CI 0.99–1.03); P = 0.31] AMI-CA admissions. Length of hospital stay, total hospitalization charges and discharge dispositions for AMI-CA admissions were comparable across the seasons. Conclusions AMI-CA admissions in the winter were associated with lower rates of coronary angiography and PCI, and higher rates of in-hospital mortality compared to the other seasons.

scholarly journals Safety and Costs of Stroke Unit Admission for Select Acute Intracerebral Hemorrhage Patients

2017 ◽  
Vol 8 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Corey R. Fehnel ◽  
Kimberly M. Glerum ◽  
Linda C. Wendell ◽  
N. Stevenson Potter ◽  
Brian Silver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Stroke Unit ◽  
Skilled Nursing Facility ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Group 5

Background and Purpose: There are limited data to guide intensive care unit (ICU) versus dedicated stroke unit (SU) admission for intracerebral hemorrhage (ICH) patients. We hypothesized select patients can be safely cared for in SU versus ICU at lower costs. Methods: We conducted a retrospective cohort study of consecutive patients with predefined minor ICH (≤20 cm3, supratentorial, no coagulopathy) receiving care in either an ICU or an SU. Multiple linear regression and inverse probability weighting were used to adjust for differences in patient characteristics and nonrandom ICU versus SU assignment. The primary outcome was poor functional status at discharge (modified Rankin score [mRS] ≥3). Secondary outcomes included complications, discharge disposition, hospital length of stay, and direct inpatient costs. Results: The study population included 104 patients (41 admitted to the ICU and 63 admitted to the SU). After controlling for differences in baseline characteristics, there were no differences in poor functional outcome at discharge (93% vs 85%, P = .26) or in mean mRS (2.9 vs 3.0, P = .73). Similarly, there were no differences in the rates of complications (6% vs 10%, P = .44), discharged dead or to a skilled nursing facility (8% vs 13%, P = .59), or direct patient costs (US$7100 vs US$6200, P = .33). Median length of stay was significantly longer in the ICU group (5 vs 4 days, P = .01). Conclusions: This study revealed a shorter length of stay but no large differences in functional outcome, safety, or cost among patients with minor ICH admitted to a dedicated SU compared to an ICU.

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