title: Long-term neurological outcomes in adults with traumatic intracranial hemorrhage admitted to ICU versus floor.
abstract: BACKGROUND
  The objective of this study was to compare long-term neurological outcomes in low-risk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor.
  
  
  METHODS
  This retrospective study was conducted at a Level 1 trauma center from October 1, 2008, to February 1, 2013. We defined low-risk patients as age less than 65 years, isolated head injury, normal admission mental status, and no shift or swelling on initial head CT (computed tomography). Clinical data were abstracted from a trauma registry and linked to a brain injury database. We compared the Extended Glasgow Outcome Scale (GOS-E) score at six months between patients admitted to the ICU and patients admitted to the floor. We did a risk-adjusted analysis of the influence of floor admission on a normal GOS-E.
  
  
  RESULTS
  We identified 151 patients; 45 (30%) were admitted to the floor and 106 (70%) to the ICU. Twenty-three (51%; 95% CI [36-66%]) patients admitted to the floor and 55 (52%; 95% CI [42-62%]) patients admitted to the ICU had a normal GOS-E. On adjusted analysis; the odds ratio for floor admission was 0.77 (95% CI [0.36-1.64]) for a normal GOS-E at six months.
  
  
  CONCLUSIONS
  Long-term neurological outcomes in low-risk patients with tICH were not markedly different between patients admitted to the ICU and those admitted to the floor. However, we were unable to demonstrate non-inferiority on adjusted analysis. Future work aimed at a larger, prospective cohort may better evaluate the relative impacts of admission type on outcomes.
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Davis, California.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.affiliation: University of California, Davis, Center for Healthcare Policy and Research, Davis, California.
authors.forename: Joy
authors.initials: J
authors.lastname: Melnikow
authors.affiliation: University of California, Davis, Center for Healthcare Policy and Research, Davis, California.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.affiliation: University of California, Davis, Department of Neurological Surgery, Davis, California.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Shahlaie
authors.affiliation: University of California, Davis, Department of Surgery, Davis, California.
authors.forename: Garth H
authors.initials: GH
authors.lastname: Utter
authors.affiliation: University of California, Davis, Department of Surgery, Davis, California.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.affiliation: University of California, Davis, Department of Neurological Surgery, Davis, California.
authors.forename: Nancy
authors.initials: N
authors.lastname: Rudisill
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Davis, California.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D020198:Intracranial Hemorrhage, Traumatic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
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