Article
Does the subspecialty of an intensive care unit (ICU) have an impact on outcome of patients suffering from aneurysmal subarachnoid hemorrhage?
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Authors
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Dorothee Mielke
- Klinik für Neurochirurgie
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Patricia Suntheim
- Klinik für Neurochirurgie
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Martin Voit
- Klinik für Neurochirurgie
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Onnen Moerer
- Klinik für Anästhesiologie, Georg-August-Universität Göttingen
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Vesna Malinova
- Klinik für Neurochirurgie
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Veit Rohde
- Klinik für Neurochirurgie,; Klinik für Neurochirurgie, RWTH Aachen
| Published: | June 2, 2015 |
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Outline
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Objective: General intensive care units (gICU) provide care about a wide range of diseases, whereas specialty ICUs provide disease-specific care. It is still not well defined in a variety of different diseases, if the outcome is identical if patients are treated in a gICU. Aim of this study was to compare the outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) treated in a neurosurgical ICU (nICU) versus closed gICU.
Method: We retrospectively analyzed the outcome of aSAH patients treated in a nICU between 1990 and 2005 with that of patients treated in a gICU between 2005 and 2013 with identical treatment strategies. Among other parameters, we registered the initial Hunt & Hess grade, Fisher Score, the incidence of vasospasm and outcome. We performed a multivariate analysis using the logistic regression model to adjust for differences between the two groups of patients.
Results: A total of 755 patients, 488 female (64.6%) and 267 male (35.4%) with an average age of 50.5 years were included. 456 patients were assigned to group 1 (nICU) and 299 patients to group 2 (gICU). In both groups (gICU and nICU) a statistical significance was found between intial GCS (p<0,01), Fisher-grade (p<0,01) as well as Hunt and Hess grade (p<0,01) and the patient's outcome. No statistical significance was found between the patient's outcome and gender and the number of aneurysms identified. Multivariate logistic regression analysis (binary logit model) still revealed a significant difference between the patient's outcome treated in a nICU versus gICU (p=0.001) with the following variables included: GCS (p=0.07); Hunt and Hess grade (p=0.0004); age dichotomized <60 years and >60 years of age (p=0.05); sex (p=0.57); Fisher score (p=0.003) and the incidence of cerebral vasospasm (p=0.12).
Conclusions: The outcome is better if patients with aSAH are treated on a nICU. The study does not allow identifying reasons for this result. It can be assumed that the higher vigilance of a neurosurgically trained team for early detection of secondary outcome-relevant neuroworsening outweights the more overall but less detailed knowledge of the intensivist.
