Comparison of outcomes of nonsurgical spontaneous intracerebral hemorrhage based on risk factors and physician specialty.
BACKGROUND
The authors report the effects of patient risk factors and physician specialty on the clinical outcomes of patients with spontaneous intracerebral hemorrhage (ICH), who were treated nonsurgically at 3 academic medical centers. To our knowledge, there is no reported literature on the effect of physician specialty and outcomes (modified Rankin scale [mRS] score, in-hospital death, and hospital length of stay [LOS]).


METHODS
A new patent pending data-mining method, Healthcare Smart Grid, retrospectively analyzed hospital data for 129 patients with spontaneous ICH admitted to 3 (two university and one community) hospitals in a single metropolitan region and treated nonsurgically. Patients with traumatic hemorrhages and subarachnoid hemorrhages were excluded from the study. Demographic data, clinical presentation, medical risk factors, and hematoma characteristics were tested for associations with 3 outcomes: in-hospital death, mRS score at discharge, and LOS.


RESULTS
A total of 129 cases were identified in the university (77 cases) and community (52 cases) hospitals during a 20-month period (December 2005-July 2007). The mean age was 64.1 years with 48% being men and 83% being black. The median LOS among survivors was 6 days. LOS was significantly associated with physician specialty (P=.002 for both comparisons: neurologists and neurosurgeons with internists) and hemorrhage volume. Mortality in these patients was 23%. In an adjusted analysis, hemorrhage volume (P < .001) and Glasgow Coma Scale score at admission (P=.001) were significant predictors of in-hospital mortality, whereas physician specialty, number of comorbidities, and other risk factors were not. The median mRS score at discharge was 3. Larger hemorrhage volume tends to predict greater disability (P=.06).


CONCLUSIONS
LOS for spontaneous nonsurgically treated ICH tends to be the least with admission to specialist services such as neurologists and neurosurgeons. Physician specialties do not seem to influence mRS score or mortality in medically managed spontaneous ICH. Hemorrhage volume has a statistically significant association with death and LOS.
Bhattacharya
Pratik
P
Division of Vascular Neurology, Department of Neurology, Wayne State University, Detroit, Michigan 48201, USA.
Shankar
Lakshmi
L
Manjila
Sunil
S
Chaturvedi
Seemant
S
Madhavan
Ramesh
R
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000628:therapy*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D057225:Data Mining / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008824:Michigan; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data; D009493:Neurosurgery / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis