Year: 2012
Type: article
Study design: Observational Study
Abstract: STUDY OBJECTIVE: Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables. METHODS: A structured, historical cohort study of adult patients (aged 18 years and older) with minor traumatic intracranial hemorrhage was conducted within a consortium of 8 Level I trauma centers in the western United States from January 2005 to June 2010. The study population included patients with minor traumatic intracranial hemorrhage, defined as an emergency department (ED) Glasgow Coma Scale (GCS) score of 15 (normal mental status) and an Injury Severity Score less than 16 (no other major organ injury). The primary outcome measure was initial ICU admission. The secondary outcome measure was a critical care intervention during hospitalization. Critical care interventions included mechanical ventilation, neurosurgical intervention, transfusion of blood products, vasopressor or inotrope administration, and invasive hemodynamic monitoring. ED disposition and the proportion of ICU patients not receiving a critical care intervention were compared across sites with descriptive statistics. The association between ICU admission and predetermined independent variables was analyzed with multivariable regression. RESULTS: Among 11,240 adult patients with traumatic intracranial hemorrhage, 1,412 (13%) had minor traumatic intracranial hemorrhage and complete ED disposition data (mean age 48 years; SD 20 years). ICU use within this cohort across sites ranged from 50% to 97%. Overall, 847 of 888 patients (95%) with minor traumatic intracranial hemorrhage who were admitted to the ICU did not receive a critical care intervention during hospitalization (range between sites 80% to 100%). Three of 524 (0.6%) patients discharged home or admitted to the observation unit or ward received a critical care intervention. After controlling for severity of injury (age, blood pressure, and Injury Severity Score), study site was independently associated with ICU admission (odds ratios ranged from 1.5 to 30; overall effect P<.001). CONCLUSION: Across a consortium of trauma centers in the western United States, there was wide variability in ICU use within a cohort of patients with minor traumatic intracranial hemorrhage. Moreover, a large proportion of patients admitted to the ICU never required a critical care intervention, indicating the potential to improve use of critical care resources in patients with minor traumatic intracranial hemorrhage.
Source: Annals of Emergency Medicine
Institutions: University of California Davis Medical Center, UC Davis Health, University of California, Davis, Denver Health Medical Center, University of Colorado Denver, Oregon Health & Science University, Stanford Medicine, Stanford University, University of Washington, University of Nevada, Las Vegas, University of California, San Francisco, University of California San Francisco Medical Center, University of Utah
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,850
Funders: Robert Wood Johnson Foundation, University of Washington, Institute of Translational Health Sciences, National Institutes of Health, School of Medicine, Stanford University, University of California, Davis, Oregon Clinical and Translational Research Institute, University of California, San Francisco, School of Medicine, Center for Clinical and Translational Science, University of Utah, National Center for Research Resources, National Center for Advancing Translational Sciences, School of Medicine, University of California, San Francisco
Awards: EXTRAMURAL RESEARCH FACILITIES CONSTRUCTION, G1114177658, G1160208864, G1290979756, G1516365345, G1609126075, G1616868727, Clinical and Translational Science Institute, G187300890, Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G3045624900, G3762298635, University of Utah Center for Clinical and Translational Science-UL1, G3978177861, G3985809501, G4462812583, G475936976, G5198420484, G5813117173, G6464695680, G6719544525, G758528517, Institute of Translational Health Sciences, G795481715, G801436702, G889458973, G9000005258, G9000005717, G9000021615, G9000033828, G9000058261, G9000060836, G9000198303, G9000233244, G932371335
OpenAlex ID: W2080646114