title: Intraventricular thrombolysis in intracerebral hemorrhage requiring ventriculostomy: a decade-long real-world experience.
abstract: OBJECTIVE
  Intraventricular thrombolysis (IVT) is a promising treatment in facilitating intraventricular clot resolution after intraventricular hemorrhage. We examined in-hospital outcomes and resource utilization after thrombolysis in patients with intraventricular hemorrhage requiring ventriculostomy in a real-world setting.
  
  
  METHODS
  We identified adult patients with primary diagnosis of nontraumatic intracerebral hemorrhage requiring ventriculostomy from the Nationwide Inpatient Sample from 2002 to 2011. We compared demographic and hospital characteristics, comorbidities, inpatient outcomes, and resource utilization measures between patients treated with IVT and those managed with ventriculostomy, but without IVT. Population estimates were extrapolated using standard Nationwide Inpatient Sample weighting algorithms.
  
  
  RESULTS
  We included 34 044 patients in the analysis, of whom 1133 (3.3%) received IVT. The thrombolysis group had significantly lower inpatient mortality (32.4% versus 41.6%; P=0.001) and it remained lower after controlling for baseline demographics, hospital characteristics, comorbidity, case severity, and withdrawal of care status (adjusted odds ratio, 0.670; 95% confidence interval, 0.520-0.865; P=0.002). There was a trend toward favorable discharge (home or rehabilitation) among the thrombolysis cohort (adjusted odds ratio, 1.335; 95% confidence interval, 0.983-1.812; P=0.064). The adjusted rates of bacterial meningitis and ventricular shunt placement were similar between groups. The thrombolysis group had longer length of stay and higher inflation-adjusted cost of care, but cost of care per day length of stay was similar to the non-IVT group.
  
  
  CONCLUSIONS
  IVT for intracerebral hemorrhage requiring ventriculostomy resulted in lower inpatient mortality and a trend toward favorable discharge outcome with similar rates of inpatient complications compared with the non-IVT group.
authors: From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD. yogeshmoradiyamd@gmail.com.
authors: Yogesh
authors: Y
authors: Moradiya
authors: From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Santosh B
authors: SB
authors: Murthy
authors: From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors: David E
authors: DE
authors: Newman-Toker
authors: From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Daniel F
authors: DF
authors: Hanley
authors: From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Wendy C
authors: WC
authors: Ziai
mesh_terms: D000368:Aged; D000465:Algorithms; D002543:Cerebral Hemorrhage / Q000503:physiopathology* / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*
chemical_list: D010959:Tissue Plasminogen Activator
keywords: cerebral hemorrhage; cerebrospinal fluid shunt; meningitis; mortality; thrombolytic therapy; ventriculostomy