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Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor

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 tr...

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Autores principales: Nishijima, Daniel K., Melnikow, Joy, Tancredi, Daniel J., Shahlaie, Kiarash, Utter, Garth H., Galante, Joseph M., Rudisill, Nancy, Holmes, James F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380380/
https://www.ncbi.nlm.nih.gov/pubmed/25834671
http://dx.doi.org/10.5811/westjem.2015.1.23356
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author Nishijima, Daniel K.
Melnikow, Joy
Tancredi, Daniel J.
Shahlaie, Kiarash
Utter, Garth H.
Galante, Joseph M.
Rudisill, Nancy
Holmes, James F.
author_facet Nishijima, Daniel K.
Melnikow, Joy
Tancredi, Daniel J.
Shahlaie, Kiarash
Utter, Garth H.
Galante, Joseph M.
Rudisill, Nancy
Holmes, James F.
author_sort Nishijima, Daniel K.
collection PubMed
description 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.
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spelling pubmed-43803802015-04-01 Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor Nishijima, Daniel K. Melnikow, Joy Tancredi, Daniel J. Shahlaie, Kiarash Utter, Garth H. Galante, Joseph M. Rudisill, Nancy Holmes, James F. West J Emerg Med Health Outcomes 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. Department of Emergency Medicine, University of California, Irvine School of Medicine 2015-03 2015-03-02 /pmc/articles/PMC4380380/ /pubmed/25834671 http://dx.doi.org/10.5811/westjem.2015.1.23356 Text en Copyright © 2015 the authors. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Outcomes
Nishijima, Daniel K.
Melnikow, Joy
Tancredi, Daniel J.
Shahlaie, Kiarash
Utter, Garth H.
Galante, Joseph M.
Rudisill, Nancy
Holmes, James F.
Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor
title Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor
title_full Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor
title_fullStr Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor
title_full_unstemmed Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor
title_short Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor
title_sort long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to icu versus floor
topic Health Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380380/
https://www.ncbi.nlm.nih.gov/pubmed/25834671
http://dx.doi.org/10.5811/westjem.2015.1.23356
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