title: Type of admission is associated with outcome of spontaneous subarachnoid hemorrhage.
abstract: BACKGROUND
  Admitting facility may significantly affect outcome for spontaneous subarachnoid hemorrhage patients. We assessed outcomes of patients admitted directly to a comprehensive stroke center with those initially admitted to a general hospital and subsequently transferred. The comprehensive stroke center included a neurocritical care ICU, cerebrovascular neurosurgeons and endovascular specialists.
  
  
  METHODS
  We identified 107 consecutive spontaneous subarachnoid hemorrhage cases. Of these cases, 31 (29%) patients were admitted directly and 76 (71%) were transferred from general hospitals. Univariate and multivariate analyses evaluated differences in mortality, complications, discharge disposition, and in-hospital length of stay.
  
  
  RESULTS
  Differences in baseline parameters (age, gender, admission Glasgow Coma Scale, Fisher grade, admission Hunt and Hess grade) were not statistically significant between direct-admit and transfer patients at our institution. Transferred patients developed vasospasm more frequently (58% vs. 32%; P < 0.05) and had a longer delay time to surgery (3.9-days vs. 2.4-days: P < 0.05). Multivariate analysis showed that the likelihood of vasospasm was significantly higher for transfer patients (OR 3.46, CI: 1.2-10.3, P = 0.03). In addition, longer in-hospital stays and higher odds of non-routine discharge were observed in transferred patients (P < 0.01). No differences in outcome could be identified for surgical vs. endovascular treatment rates between direct-admit and transfer patients. An association, but no causative link, can be made between the effect of transfer and the outcomes of SAH patients due to the retrospective nature of our study.
  
  
  CONCLUSIONS
  Spontaneous subarachnoid hemorrhage patients admitted directly to our comprehensive stroke center showed less complications compared to those transferred from general hospitals. This improvement was independent of time to treatment. Additional research in multiple centers using prospective analysis should be conducted to confirm that preferential direct transport to a comprehensive stroke center would likely yield considerable improvements in public health.
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Rosner
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Alexander
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Wouter I
authors.initials: WI
authors.lastname: Schievink
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.|Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Palestrant
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.|Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lyden
authors.affiliation: Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.|Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000628:therapy*; D020301:Vasospasm, Intracranial / Q000453:epidemiology; D055815:Young Adult
keywords: admitting facility; comprehensive stroke center; neurovascular center; subarachnoid hemorrhage; tertiary care center; vasospasm