医学
蛛网膜下腔出血
冲程(发动机)
改良兰金量表
急诊医学
重症监护室
作者
Laura Llull,G. Mayà,Ramon Torné,Ricard Mellado-Artigas,Arturo Renú,Antonio López-Rueda,Carlos Laredo,Diego Culebras,Carlos Ferrando,Jordi Blasco,Sergio Amaro,Ángel Chamorro
摘要
Background According to current guidelines, aneurysmal subarachnoid haemorrhage (aSAH) patients are mostly managed in intensive care units (ICU) regardless of baseline severity. We assessed the prognostic and economic implications of initial admission of low-grade aSAH patients into a Stroke Unit (SU) compared to initial ICU admission. Methods We reviewed prospectively registered data from consecutive aSAH patients with a WFNS grade lower than 3 admitted at a Comprehensive Stroke Center between April-2013 and September-2018. Clinical and radiological baseline traits, in-hospital complications, length of hospital stay (LOS) and poor outcome at 90 days (modified Rankin Scale >2) were compared between the ICU and SU groups in the whole population and in a propensity score matched cohort. Results From 131 patients, 74 (56%) were initially admitted in the ICU and 57 (44%) in the SU. In-hospital complication rates were similar in the ICU and SU groups and included rebleeding (10% vs 7%, p=0.757), angiographic vasospasm (61% vs 60%, p=0.893), delayed cerebral ischemia (12% vs 12%, p=0.984), pneumonia (6% vs 4%, p=0.697) and death (10% vs 5%, p=0.512). LOS did not differ across both groups [median (IQR) 22 (16-30) vs 19 (14-26) days, p=0.160]. In adjusted multivariate models, the location of initial admission was not associated with long-term poor outcome either in the whole population (OR=1.16, 95%CI=0.32-4.19, p=0.825) or in the matched cohort (OR=0.98, 95%CI=0.24-4.06, p=0.974). Conclusions A dedicated SU cared by a multidisciplinary team might be an optimal alternative to ICU to initially admit patients with low-risk aSAH.
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