Early predictors of prolonged stay in a critical care unit following aneurysmal subarachnoid hemorrhage.
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is a neurologic emergency that typically warrants initial monitoring in a critical care setting. The aim of this study is to identify clinical and radiologic features on admission that predict a protracted critical care admission following aSAH.


METHODS
Exploratory posthoc analysis was performed on the 413 patients enrolled in Clazosentan to Overcome Neurological iSChemia and Infarction OccUrring after Subarachnoid hemorrhage (CONSCIOUS-1), a prospective randomized control trial of clazosentan for the prevention of vasospasm after aSAH. The association between potential clinical and radiographic covariates, and the length of stay (LOS) in a critical care unit after aSAH was determined using a Cox proportional hazards model. Covariates with a significance level of p < 0.20, on univariate analysis, were entered into a multivariate forward conditional analysis to identify independent predictors of prolonged LOS.


RESULTS
The mean LOS was 12.6 ± 10.6 days. On multivariate analysis, age (hazard ratio [HR] 1.01, 95 % confidence interval [CI] 1.00-1.02; p = 0.032), a history of hypertension (HR 1.30, CI 1.01-1.67; p = 0.045), and a World Federation of Neurosurgical Societies Score of IV-V on admission (HR 1.38, CI 1.05-1.81; p = 0.02) were the clinical features associated with a greater critical care LOS following aSAH. Intracerebral hemorrhage (HR 1.50, CI 1.03-2.21; p = 0.004) and increasing intraventricular clot burden (HR 1.08, CI 1.03-1.14; p = 0.037) on admission computed tomography were the radiologic features associated with prolonged LOS.


CONCLUSIONS
We have identified several early risk factors associated with a prolonged critical care stay following aSAH.
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada. christopher.witiw@mail.utoronto.ca
Christopher D
CD
Witiw
George M
GM
Ibrahim
Aria
A
Fallah
R Loch
RL
Macdonald
D000328:Adult; D000367:Age Factors; D017542:Aneurysm, Ruptured / Q000150:complications / Q000453:epidemiology*; D001921:Brain / Q000000981:diagnostic imaging*; D002552:Cerebral Ventricles; D004146:Dioxanes / Q000627:therapeutic use; D065130:Endothelin A Receptor Antagonists; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D002532:Intracranial Aneurysm / Q000150:complications / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D013449:Sulfonamides / Q000627:therapeutic use; D013777:Tetrazoles / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control
D004146:Dioxanes; D065130:Endothelin A Receptor Antagonists; D011725:Pyridines; D011743:Pyrimidines; D013449:Sulfonamides; D013777:Tetrazoles; C109641:clazosentan