title: Early versus late readmission of subarachnoid haemorrhage patients into neurocritical care.
abstract: BACKGROUND
  Subarachnoid haemorrhage (SAH) patients will typically require monitoring in a specialised Neurocritical Care Unit (NCCU) regardless of the primary treatment modality. Once discharged from NCCU, readmission within 48 h is regarded as a "failed" discharge. The aims of this study are to (1) Evaluate the readmission rate of SAH patients into NCCU, (2) Identify the indications for readmission, (3) Analyse clinical parameters on discharge between patients readmitted early and late.
  
  
  METHODS
  Retrospective observational study of the Intensive Care National Audit and Research Centre (ICNARC) database of patients from our unit diagnosed with SAH from January 2009-December 2014, who were readmitted into NCCU. Demographic data, World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, length of initial and subsequent NCCU stay, time of readmission, indication for readmission, and mortality rate data were collected. Patients were categorised by early (<48 h) and late (>48 h) readmission, and their clinical parameters on NCCU discharge were statistically analysed.
  
  
  RESULTS
  Five hundred and seventy-five SAH patients were admitted into NCCU, of which 49 patients (9%) were readmitted after discharge to ward-level care. The mean age of readmitted patients was 64.1 ± 11.6 years old. The most common indications were delayed cerebral ischaemia (DCI) (50%) and infection (19%). Readmitted SAH patients were typically WFNS grade I-II (n = 22) and Fisher grade III-IV (n = 44). 17 (35%) patients were readmitted early, and were older (p = 0.0049) with a lower GCS (p = 0.0077) compared to patients readmitted later. White cell count and C-reactive protein were higher in patients readmitted early, but did not reach statistical significance (p = 0.09, p = 0.07).
  
  
  CONCLUSIONS
  DCI and infection were the most common indications for NCCU readmission in SAH patients. "Failed" discharged patients from NCCU are typically older with a lower GCS than patients readmitted after 48 h, and therefore clinicians should be more cautious in discharging these patients prematurely.
authors.affiliation: a South West Neurosurgical Centre , Derriford Hospital , Plymouth , UK ;
authors.forename: Jacob C M
authors.initials: JC
authors.lastname: Low
authors.affiliation: b Department of Critical Care , Derriford Hospital , Plymouth , UK.
authors.forename: Jessie
authors.initials: J
authors.lastname: Welbourne
authors.affiliation: b Department of Critical Care , Derriford Hospital , Plymouth , UK.
authors.forename: Helen
authors.initials: H
authors.lastname: McMillan
authors.affiliation: a South West Neurosurgical Centre , Derriford Hospital , Plymouth , UK ;
authors.forename: Peter C
authors.initials: PC
authors.lastname: Whitfield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002097:C-Reactive Protein / Q000032:analysis; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000209:etiology / Q000628:therapy; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000601:surgery*; D017211:Treatment Failure; D006113:United Kingdom
chemical_list: D002097:C-Reactive Protein
keywords: Delayed cerebral ischaemia; early readmission; readmission to NCCU; subarachnoid haemorrhage