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Factors Associated with the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage: The Triage ICH Model

Klaas, James P
Author Klaas, James P Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. klaas.james@mayo.edu
Braksick, Sherri
Author Braksick, Sherri Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
Mandrekar, Jay
Author Mandrekar, Jay Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
Sedova, Petra
Author Sedova, Petra Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
Bellolio, M Fernanda
Author Bellolio, M Fernanda Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
Rabinstein, Alejandro A
Author Rabinstein, Alejandro A Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
Brown, Robert D Jr
Author Brown, Robert D Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

Neurocritical care. 2017 Aug ; 27 (1) : 75-81.

Neurocrit Care
ISSN 1556-0961 | 1541-6933
Source

Language English Country United States Media print

Document type Journal Article, Observational Study

Persistent link https://www.medvik.cz/link/pmid28028788

PubMed 28028788
DOI 10.1007/s12028-016-0346-7
PII: 10.1007/s12028-016-0346-7
Knihovny.cz E-resources

Keywords
Intensive care, Intracerebral hemorrhage, Triage,
MeSH
Cerebral Hemorrhage diagnosis diagnostic imaging therapy MeSH
Glasgow Outcome Scale * MeSH
Cerebral Intraventricular Hemorrhage diagnosis therapy MeSH
Intensive Care Units statistics & numerical data MeSH
Middle Aged MeSH
Humans MeSH
Models, Neurological MeSH
Patient Admission statistics & numerical data MeSH
Retrospective Studies MeSH
Aged, 80 and over MeSH
Aged MeSH
Triage methods standards MeSH
Check Tag
Middle Aged MeSH
Humans MeSH
Male MeSH
Aged, 80 and over MeSH
Aged MeSH
Female MeSH
Publication type
Journal Article MeSH
Observational Study MeSH

BACKGROUND: Providing the correct level of care for patients with intracerebral hemorrhage (ICH) is crucial, but the level of care needed at initial presentation may not be clear. This study evaluated factors associated with admission to intensive care unit (ICU) level of care. METHODS: This is an observational study of all adult patients admitted to our institution with non-traumatic supratentorial ICH presenting within 72 h of symptom onset between 2009-2012 (derivation cohort) and 2005-2008 (validation cohort). Factors associated with neuroscience ICU admission were identified via logistic regression analysis, from which a triage model was derived, refined, and retrospectively validated. RESULTS: For the derivation cohort, 229 patients were included, of whom 70 patients (31 %) required ICU care. Predictors of neuroscience ICU admission were: younger age [odds ratio (OR) 0.94, 95 % CI 0.91-0.97; p = 0.0004], lower Full Outline of UnResponsiveness (FOUR) score (0.39, 0.28-0.54; p < 0.0001) or Glasgow Coma Scale (GCS) score (0.55, 0.45-0.67; p < 0.0001), and larger ICH volume (1.04, 1.03-1.06; p < 0.0001). The model was further refined with clinician input and the addition of intraventricular hemorrhage (IVH). GCS was chosen for the model rather than the FOUR score as it is more widely used. The proposed triage ICH model utilizes three variables: ICH volume ≥30 cc, GCS score <13, and IVH. The triage ICH model predicted the need for ICU admission with a sensitivity of 94.3 % in the derivation cohort [area under the curve (AUC) = 0.88; p < 0.001] and 97.8 % (AUC = 0.88) in the validation cohort. CONCLUSIONS: Presented are the derivation, refinement, and validation of the triage ICH model. This model requires prospective validation, but may be a useful tool to aid clinicians in determining the appropriate level of care at the time of initial presentation for a patient with a supratentorial ICH.

Department of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA

Department of Emergency Medicine Mayo Clinic Rochester MN USA

Department of Neurology Faculty of Medicine St Anne's University Hospital Masaryk University Brno Czech Republic

Department of Neurology Mayo Clinic 200 1st Street SW Rochester MN 55905 USA

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

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