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Comparative Study
. 2015 Mar;16(2):284-90.
doi: 10.5811/westjem.2015.1.23356. Epub 2015 Mar 2.

Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor

Daniel K Nishijima  1 , Joy Melnikow  2 , Daniel J Tancredi  2 , Kiarash Shahlaie  3 , Garth H Utter  4 , Joseph M Galante  4 , Nancy Rudisill  3 , James F Holmes  1
Affiliations
Comparative Study

Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor

Daniel K Nishijima et al. West J Emerg Med. 2015 Mar.

Abstract

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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Figures

Figure 1
Figure 1
Flow of patients in the study. tlCH, traumatic intracranial hemorrhage; GOS-E, Glassgow Outcome Score Extended; ICU, intensive care unit a Low-risk defined as admission Glasgow Coma Scale score of 15, isolated head injury (defined as Abbreviated Injury Score less than three in all non-head body regions), age less than 65 years old, and initial head computed tomography imaging without evidence of shift or mass effect.
Figure 2
Figure 2
Distribution of independent variables by admission location. ICU, intensive care unit; CT, computed tomography; AIS, abbreviated injury score
Figure 3
Figure 3
Distribution of outcome measures by admission location. GOS-E, extended Glassgow Outcome Score; ICU, intensive care unit
Figure 4
Figure 4
Adjusted odds ratio of floor admission on extended Glosgow Outcome Score (GOS-E) at six months (non-inferiority is not established).
See this image and copyright information in PMC

References

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