Should mild or moderate stroke patients be admitted to an intensive care unit?
OBJECTIVE
Inhospital placement of patients with mild (National Institutes of Health Stroke Scale [NIHSS] score <8) or moderate (NIHSS 8 through 16) acute strokes is variable. We assessed the outcome of such patients based on intensive care unit (ICU) versus general ward placement.


METHODS
We reviewed 138 consecutive patients admitted within 24 hours of stroke onset to 2 physically adjacent hospitals with different admitting practices. Outcome measures included complication rates, discharge Rankin scale score, hospital discharge placement, costs, and length of stay (LOS).


RESULTS
Hospital A, a 626-bed university-affiliated hospital, admitted 43% of mild and moderate strokes (MMS) to an ICU (26% of mild, 74% of moderate), whereas hospital B, a 618-bed community facility, admitted 18% of MMS to an ICU (3% of mild, 45% of moderate; P<0.004). There were no significant differences in outcomes between the 2 hospitals. Analysis of only patients admitted to hospital A, and of all patients, demonstrated that mild stroke patients admitted to the general ward had fewer complications and more favorable discharge Rankin scale scores than similar patients admitted to an ICU. There was no statistically significant difference in LOS, but total room costs for a patient admitted first to the ICU averaged $15 270 versus $3638 for admission directly to the ward.


CONCLUSIONS
While limited by the retrospective nature of our study, routinely admitting acute MMS patients to an ICU provides no cost or outcomes benefits.
Department of Neurology, UT-Houston Medical School, Houston, Tex, and Ochsner Clinic, New Orleans, La, USA.
D E
DE
Briggs
R A
RA
Felberg
M D
MD
Malkoff
P
P
Bratina
J C
JC
Grotta
D017677:Age Distribution; D000368:Aged; D003710:Demography; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D014218:Triage / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States