title: Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage.
abstract: OBJECTIVE
  To determine whether mortality rate after intracerebral hemorrhage (ICH) is lower in patients admitted to a neurologic or neurosurgical (neuro) intensive care unit (ICU) compared to those admitted to general ICUs.
  
  
  BACKGROUND
  The utility of specialty ICUs is debated. From a cost perspective, having fewer larger ICUs is preferred. Alternatively, the impact of specialty ICUs on patient outcome is unknown. Patients with ICH are admitted routinely to both general and neuro ICUs and provide an opportunity to address this question.
  
  
  METHODS
  Forty-two neuro, medical, surgical, and medical-surgical ICUs.
  
  
  RESULTS
  The study was an analysis of data prospectively collected by Project Impact over 3 yrs from 42 participating ICUs (including one neuro ICU) across the country. The records of 36,986 patients were merged with records of 3,298 patients from a second neuro ICU that collected the same data over the same period. The impact of clinical (age, race, gender, Glasgow Coma Scale score, reason for admission, insurance), ICU (size, number of ICH patients, full-time intensivist, clinical service, American College for Graduate Medical Education or Critical Care Medicine fellowship), and institutional (size, location, medical school affiliation) characteristics on hospital mortality rate of ICH patients was assessed by using a forward-enter multivariate analysis. Data from 1,038 patients were included. The 13 ICUs that admitted >20 patients accounted for 83% of the admissions with a mortality rate that ranged from 25% to 64%. Multivariate analysis adjusted for patient demographics, severity of ICH, and ICU and institutional characteristics indicated that not being in a neuro ICU was associated with an increase in hospital mortality rate (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.65-7.6). Other factors associated with higher mortality rate were greater age (OR, 1.03/year; 95% CI, 1.01-1.04), lower Glasgow Coma Scale score (OR, 0.6/point; 95% CI, 0.58-0.65), fewer ICH patients (OR, 1.01/patient; 95% CI, 1.00-1.01), and smaller ICU (OR, 1.1/bed; 95% CI, 1.02-1.13). Having a full time intensivist was associated with lower mortality rate (OR, 0.388; 95% CI, 0.22-0.67).
  
  
  CONCLUSIONS
  For patients with acute ICH, admission to a neuro vs. general ICU is associated with reduced mortality rate.
authors.affiliation: Neurology/Neurosurgery Intensive Care Unit, Department of Neurology and Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA. diringerm@neuro.wustl.edu
authors.forename: M N
authors.initials: MN
authors.lastname: Diringer
authors.forename: D F
authors.initials: DF
authors.lastname: Edwards
mesh_terms: D018806:APACHE; D017677:Age Distribution; D000368:Aged; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006276:Health Facility Size / Q000706:statistics & numerical data; D006302:Health Services Research; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000600:supply & distribution; D008875:Middle Aged; D015999:Multivariate Analysis; D009493:Neurosurgery; D009935:Organizational Affiliation; D010343:Patient Admission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology