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Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor.

Nishijima DK, Melnikow J, Tancredi DJ, Shahlaie K, Utter GH, Galante JM, Rudisill N, Holmes JF - West J Emerg Med (2015)

Bottom Line: We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor.However, we were unable to demonstrate non-inferiority on adjusted analysis.Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

View Article: PubMed Central - PubMed

Affiliation: University of California, Davis, Department of Emergency Medicine, Davis, California.

ABSTRACT

Introduction: The objective of this study was to compare long-term neurological outcomes in low-risk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor.

Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E.

Results: We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months.

Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

No MeSH data available.


Related in: MedlinePlus

Distribution of outcome measures by admission location.GOS-E, extended Glassgow Outcome Score; ICU, intensive care unit
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f3-wjem-16-284: Distribution of outcome measures by admission location.GOS-E, extended Glassgow Outcome Score; ICU, intensive care unit

Mentions: Distributions of GOS-E at six months and hospital length of stay by ED disposition are shown in Figure 3. On adjusted analysis, floor admission had an odds ratio of 0.77 (95% CI [0.36–1.64]) for a GOS-E score of 8 at six months. Given our tolerance margin of an odds ratio of 0.5, we failed to reject the hypothesis of non-inferiority (Figure 4). Only age was significantly associated with a normal GOS-E at six months (Table 4a). No variable was significant on adjusted analysis of hospital length of stay (Table 4b). In the sensitivity analysis, no variable was associated with GOS-E scores 7 and 8.


Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor.

Nishijima DK, Melnikow J, Tancredi DJ, Shahlaie K, Utter GH, Galante JM, Rudisill N, Holmes JF - West J Emerg Med (2015)

Distribution of outcome measures by admission location.GOS-E, extended Glassgow Outcome Score; ICU, intensive care unit
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4380380&req=5

f3-wjem-16-284: Distribution of outcome measures by admission location.GOS-E, extended Glassgow Outcome Score; ICU, intensive care unit
Mentions: Distributions of GOS-E at six months and hospital length of stay by ED disposition are shown in Figure 3. On adjusted analysis, floor admission had an odds ratio of 0.77 (95% CI [0.36–1.64]) for a GOS-E score of 8 at six months. Given our tolerance margin of an odds ratio of 0.5, we failed to reject the hypothesis of non-inferiority (Figure 4). Only age was significantly associated with a normal GOS-E at six months (Table 4a). No variable was significant on adjusted analysis of hospital length of stay (Table 4b). In the sensitivity analysis, no variable was associated with GOS-E scores 7 and 8.

Bottom Line: We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor.However, we were unable to demonstrate non-inferiority on adjusted analysis.Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

View Article: PubMed Central - PubMed

Affiliation: University of California, Davis, Department of Emergency Medicine, Davis, California.

ABSTRACT

Introduction: The objective of this study was to compare long-term neurological outcomes in low-risk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor.

Methods: This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E.

Results: We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months.

Conclusion: Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.

No MeSH data available.


Related in: MedlinePlus