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Early Predictors of Prolonged Stay in a Critical Care Unit Following Aneurysmal Subarachnoid Hemorrhage
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Early Predictors of Prolonged Stay in a Critical Care Unit Following Aneurysmal Subarachnoid Hemorrhage
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Journal Article
Early Predictors of Prolonged Stay in a Critical Care Unit Following Aneurysmal Subarachnoid Hemorrhage
2013
Overview
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.
Publisher
Humana Press Inc,Springer Nature B.V
Subject
/ Age
/ Aneurysm, Ruptured - complications
/ Aneurysm, Ruptured - epidemiology
/ Endothelin A Receptor Antagonists
/ Female
/ Glucose
/ Hematoma
/ Humans
/ Hypertension - complications
/ Intensive Care Units - statistics & numerical data
/ Intracranial Aneurysm - complications
/ Intracranial Aneurysm - epidemiology
/ Length of Stay - statistics & numerical data
/ Male
/ Medicine
/ Nicotine
/ Patients
/ Pyrimidines - therapeutic use
/ Stroke
/ Subarachnoid Hemorrhage - diagnostic imaging
/ Subarachnoid Hemorrhage - epidemiology
/ Subarachnoid Hemorrhage - etiology
/ Sulfonamides - therapeutic use
/ Tetrazoles - therapeutic use
/ Vasospasm, Intracranial - etiology
