Article Text
Abstract
Background Patients with intracerebral haemorrhage (ICH) are frequently transferred between hospitals for higher level of care. We aimed to identify factors associated with resource utilisation among patients with ICH admitted to a single academic hospital.
Methods We used a prospectively collected registry of consecutive patients with primary ICH at an urban academic hospital between 1 January 2005 and 31 December 2015. The primary outcome was use of either intensive care unit (ICU) admission or surgical intervention. Logistic regression examined factors associated with the outcome, controlling for age, sex, Glasgow coma score (GCS) and ICH score.
Results Of the 2008 patients included, 887 (44.2%) received ICU stay or surgical intervention. These patients were younger (71 vs 74 years, p<0.001), less often white (83.9% vs 89.3%, p<0.001), had lower baseline GCS (12 vs 14, p<0.001) and more frequently had intraventricular haemorrhage (58.6% vs 43.4%, p<0.001). Factors independently associated with ICU stay or surgical intervention were age >65 years (OR 0.38, 95% CI 0.21 to 0.69), GCS <15 (1.23, 95% CI 1.01 to 1.52) and ICH score >0 (OR 2.23, 95% CI 1.70 to 2.91).
Conclusion Among this cohort of primary patients with ICH, GCS of 15 and ICH score of 0 were associated with less frequent use of ICU or intervention. These results should be validated in a larger sample but may be valuable for hospitals considering which patients with ICH could safely remain at the referring facility.
- intracranial hemorrhage
- interhospital transfer
- resource utilization
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Footnotes
Contributors KSZ, JNG and LHS conceived and designed the study. SM takes responsibility for the integrity of the data and the analyses. All authors participated in critical review of results and drafting and critical revisions of the manuscript, and KSZ takes responsibility for the paper as a whole.
Funding This work was supported by the Agency for Healthcare Research & Quality K08HS024561 (PI: KSZ).
Competing interests KSZ reports research funding from the Agency for Healthcare Research, National Institutes of Health and CRICO, and consulting relationship with Portola Pharmaceuticals. JR reports research funding from the National Institutes of Health, and consulting relationships with Boehringer Ingelheim, Pfizer and New Beta Innovations. LHS reports research relationships with the National Institutes of Health and Genetech, and consulting relationships with the Massachusetts Department of Public Health, Medtronic and Genetech. JNG has research relationships with Portola Pharmaceuticals, Octapharma and Pfizer, and consulting relationships with CSL Behring, Octapharma, Portola and Phillips.
Patient consent for publication Not required.
Ethics approval The study was approved by the hospital’s Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.