title: Medical complications drive length of stay after brain hemorrhage: a cohort study.
abstract: BACKGROUND
  Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted patients.
  
  
  METHODS
  We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement, and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU and hospital LOS).
  
  
  RESULTS
  Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection, fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients with ICH the volume of the initial bleed was significant in some models.
  
  
  CONCLUSIONS
  LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary to eliminate "preventable" complications and minimize LOS after brain hemorrhage.
authors.affiliation: Department of Neurology, Northwestern University, 710 N Lake Shore Drive, 11th floor, Chicago, IL, 60611, USA. a-naidech@northwestern.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Paul
authors.initials: P
authors.lastname: Tamul
authors.forename: Sarice L
authors.initials: SL
authors.lastname: Bassin
authors.forename: Charles M
authors.initials: CM
authors.lastname: Watts
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bleck
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000473:pathology / Q000628:therapy; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy