title: Factors Associated with the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage: The Triage ICH Model.
abstract: BACKGROUND
  Providing the correct level of care for patients with intracerebral hemorrhage (ICH) is crucial, but the level of care needed at initial presentation may not be clear. This study evaluated factors associated with admission to intensive care unit (ICU) level of care.
  
  
  METHODS
  This is an observational study of all adult patients admitted to our institution with non-traumatic supratentorial ICH presenting within 72 h of symptom onset between 2009-2012 (derivation cohort) and 2005-2008 (validation cohort). Factors associated with neuroscience ICU admission were identified via logistic regression analysis, from which a triage model was derived, refined, and retrospectively validated.
  
  
  RESULTS
  For the derivation cohort, 229 patients were included, of whom 70 patients (31 %) required ICU care. Predictors of neuroscience ICU admission were: younger age [odds ratio (OR) 0.94, 95 % CI 0.91-0.97; p = 0.0004], lower Full Outline of UnResponsiveness (FOUR) score (0.39, 0.28-0.54; p < 0.0001) or Glasgow Coma Scale (GCS) score (0.55, 0.45-0.67; p < 0.0001), and larger ICH volume (1.04, 1.03-1.06; p < 0.0001). The model was further refined with clinician input and the addition of intraventricular hemorrhage (IVH). GCS was chosen for the model rather than the FOUR score as it is more widely used. The proposed triage ICH model utilizes three variables: ICH volume ≥30 cc, GCS score <13, and IVH. The triage ICH model predicted the need for ICU admission with a sensitivity of 94.3 % in the derivation cohort [area under the curve (AUC) = 0.88; p < 0.001] and 97.8 % (AUC = 0.88) in the validation cohort.
  
  
  CONCLUSIONS
  Presented are the derivation, refinement, and validation of the triage ICH model. This model requires prospective validation, but may be a useful tool to aid clinicians in determining the appropriate level of care at the time of initial presentation for a patient with a supratentorial ICH.
authors.affiliation: Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. klaas.james@mayo.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Klaas
authors.affiliation: Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Braksick
authors.affiliation: Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.|Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Mandrekar
authors.affiliation: Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.|Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Sedova
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: M Fernanda
authors.initials: MF
authors.lastname: Bellolio
authors.affiliation: Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D000074042:Cerebral Intraventricular Hemorrhage / Q000175:diagnosis / Q000628:therapy; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014218:Triage / Q000379:methods* / Q000592:standards
keywords: Intensive care; Intracerebral hemorrhage; Triage