Early Therapy Intensity Level (TIL) Predicts Mortality in Spontaneous Intracerebral Hemorrhage

Wendy C Ziai, Aazim A. Siddiqui, Natalie Ullman, Daniel B. Herrick, Gayane Yenokyan, Nichol McBee, Karen Lane, Daniel F Hanley

Research output: Contribution to journalArticle

Abstract

Background: Outcome from spontaneous intracerebral hemorrhage (sICH) may depend on patient-care variability. We developed as ICH-specific therapy intensity level (TIL) metric using evidence-based elements in a high severity sICH cohort. Methods: This is a cohort study of 170 patients with sICH and any intraventricular hemorrhage treated in 2 academic neuroICUs. Pre-defined quality indicators were identified based on current guidelines, scientific evidence, and likelihood of care documentation in first 72 h of hospital admission. We assessed performance on each indicator and association with discharge mortality. Significant indicators were aggregated to develop a TIL score. The predictive validity of the best fit TIL score was tested with threefold cross-validation of multivariate logistic regression models of in-hospital survival and good outcome (modified Rankin score 0–3). Results: Median ICH score was 3; discharge mortality was 51.2 %. Five/19 tested variables were significantly associated with lower discharge mortality: no DNR/withdrawal of treatment within 24 h of admission, target glucose within 4 h of high glucose, no recurrent hyperpyrexia, clinical reversal of herniation/intracranial pressure >20 mmHg within 60 min of detection, and reversal of INR (

Original languageEnglish (US)
Pages (from-to)188-197
Number of pages10
JournalNeurocritical Care
Volume23
Issue number2
DOIs
StatePublished - May 30 2015

Fingerprint

Cerebral Hemorrhage
Secondary Prevention
Mortality
Logistic Models
Glucose
International Normalized Ratio
Intracranial Pressure
Therapeutics
Documentation
Patient Care
Cohort Studies
Guidelines
Hemorrhage
Survival

Keywords

  • Cerebral hemorrhage
  • Intensity of care
  • Intensive care unit
  • Intracerebral hemorrhage
  • Quality indicators

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Early Therapy Intensity Level (TIL) Predicts Mortality in Spontaneous Intracerebral Hemorrhage. / Ziai, Wendy C; Siddiqui, Aazim A.; Ullman, Natalie; Herrick, Daniel B.; Yenokyan, Gayane; McBee, Nichol; Lane, Karen; Hanley, Daniel F.

In: Neurocritical Care, Vol. 23, No. 2, 30.05.2015, p. 188-197.

Research output: Contribution to journalArticle

Ziai, Wendy C ; Siddiqui, Aazim A. ; Ullman, Natalie ; Herrick, Daniel B. ; Yenokyan, Gayane ; McBee, Nichol ; Lane, Karen ; Hanley, Daniel F. / Early Therapy Intensity Level (TIL) Predicts Mortality in Spontaneous Intracerebral Hemorrhage. In: Neurocritical Care. 2015 ; Vol. 23, No. 2. pp. 188-197.
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