TY - JOUR
T1 - Risk Factor–Guided Early Discharge and Potential Resource Allocation Benefits in Patients with Traumatic Subarachnoid Hemorrhage
AU - Xu, Risheng
AU - Nair, Sumil K.
AU - Xia, Yuanxuan
AU - Liew, Jason
AU - Vo, Chau
AU - Yang, Wuyang
AU - Feghali, James
AU - Alban, Ted
AU - Tamargo, Rafael J.
AU - Chanmugam, Arjun
AU - Huang, Judy
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/7
Y1 - 2022/7
N2 - Objective: We sought to develop screening criteria predicting the lack of poor neurologic outcomes in patients presenting with traumatic subarachnoid hemorrhage (tSAH) and to evaluate their potential to improve resource allocation in these cases. Methods: We retrospectively reviewed patients presenting with tSAH to the emergency department (ED) of a tertiary-care institution from 2016 to 2018. We defined good neurologic outcomes as patients with stable/improving neurologic status, who did not require neurosurgical intervention, had no expanding bleed, and needed no hospital readmission. Univariate and multivariate models were generated to predict risk factors inversely associated with good neurologic outcome. Results: A total of 167 patients presented with tSAH from 2016 to 2018. The presence of depressed skull fracture, concomitant spinal fracture, low Glasgow Coma Scale (GCS) score, cranial nerve palsies, disorientation, concomitant hemorrhages, midline shift, increased international normalized ratio (INR), and emergent medical intervention were inversely correlated with likelihood of good neurologic outcome on univariate analysis. Multivariate regression showed that midline shift (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.05–0.89; P = 0.04), GCS score <13 (OR, 0.22; 95% CI, 0.05–0.99; P = 0.05), increased INR (OR, 0.18; 95% CI, 0.03–0.85; P = 0.04), and emergent medical intervention (OR, 0.18; 95% CI, 0.04–0.63; P = 0.01) were independently associated with lower likelihood of good neurologic outcome. Forty-six patients without any factors had good outcomes but were held in the ED or admitted to the hospital. These patients (if instead discharged directly) meant a potential cost savings of $179,172. Conclusions: In our study, we found multiple risk factors inversely associated with good neurologic outcome, namely low GCS score, midline shift, emergent medical intervention, and INR ≥1.4. Our findings may aid clinicians in determining which tSAH patients are candidates for safe early discharge.
AB - Objective: We sought to develop screening criteria predicting the lack of poor neurologic outcomes in patients presenting with traumatic subarachnoid hemorrhage (tSAH) and to evaluate their potential to improve resource allocation in these cases. Methods: We retrospectively reviewed patients presenting with tSAH to the emergency department (ED) of a tertiary-care institution from 2016 to 2018. We defined good neurologic outcomes as patients with stable/improving neurologic status, who did not require neurosurgical intervention, had no expanding bleed, and needed no hospital readmission. Univariate and multivariate models were generated to predict risk factors inversely associated with good neurologic outcome. Results: A total of 167 patients presented with tSAH from 2016 to 2018. The presence of depressed skull fracture, concomitant spinal fracture, low Glasgow Coma Scale (GCS) score, cranial nerve palsies, disorientation, concomitant hemorrhages, midline shift, increased international normalized ratio (INR), and emergent medical intervention were inversely correlated with likelihood of good neurologic outcome on univariate analysis. Multivariate regression showed that midline shift (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.05–0.89; P = 0.04), GCS score <13 (OR, 0.22; 95% CI, 0.05–0.99; P = 0.05), increased INR (OR, 0.18; 95% CI, 0.03–0.85; P = 0.04), and emergent medical intervention (OR, 0.18; 95% CI, 0.04–0.63; P = 0.01) were independently associated with lower likelihood of good neurologic outcome. Forty-six patients without any factors had good outcomes but were held in the ED or admitted to the hospital. These patients (if instead discharged directly) meant a potential cost savings of $179,172. Conclusions: In our study, we found multiple risk factors inversely associated with good neurologic outcome, namely low GCS score, midline shift, emergent medical intervention, and INR ≥1.4. Our findings may aid clinicians in determining which tSAH patients are candidates for safe early discharge.
KW - Cost savings
KW - Outcomes
KW - Traumatic subarachnoid hemorrhage
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UR - http://www.scopus.com/inward/citedby.url?scp=85129800776&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2022.04.014
DO - 10.1016/j.wneu.2022.04.014
M3 - Article
C2 - 35398576
AN - SCOPUS:85129800776
SN - 1878-8750
VL - 163
SP - e493-e500
JO - World neurosurgery
JF - World neurosurgery
ER -