Mc Lernon, Siobhan, Schwarz, Ghil, Wilson, Duncan, Ambler, Gareth, Goodwin, Russell, Shakeshaft, Clare, Cohen, Hannah, Yousry, Tarek, Salman, Rustam Al-Shahi, Lip, Gregory YH 
ORCID: 0000-0002-7566-1626 et al (show 6 more authors)
(2020)
Association between critical care admission and 6-month functional outcome after spontaneous intracerebral haemorrhage.
JOURNAL OF THE NEUROLOGICAL SCIENCES, 418.
117141-.
Abstract
<h4>Background</h4>There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH).<h4>Purpose</h4>We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome.<h4>Methods</h4>We included 825 patients with acute spontaneous non-traumatic ICH, recruited to a prospective multicenter observational study. We evaluated the characteristics associated with critical care admission and poor 6-month functional outcome (modified Rankin Scale, mRS > 3) using univariable (chi-square test and Wilcoxon rank-sum test, as appropriate) and multivariable analysis.<h4>Results</h4>286 patients (38.2%) had poor 6-month functional outcome. Seventy-seven (9.3%) patients were admitted to critical care. Patients admitted to critical care were younger (p < 0.001), had lower GCS score (p < 0.001), larger ICH volume (p < 0.001), more often had intraventricular extension (p = 0.008) and underwent neurosurgery (p < 0.001). Critical care admission was associated with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034); adjusted OR 2.43 [95%CI 1.36-4.35], p = 0.003), but not with death (OR 1.29 [95%CI 0.71-2.35; p = 0.4). In ordinal logistic regression, patients admitted to critical care showed an OR 1.47 (95% CI 0.98-2.20; p = 0.07) for a shift in the 6-month modified Rankin Scale.<h4>Conclusions</h4>Admission to critical care is associated with poor 6-month functional outcome after spontaneous ICH but not with death. Patients admitted to critical care were a priori more severely affected. Although adjusted for main known predictors of poor outcome, our findings could still be confounded by unmeasured factors. Establishing the true effectiveness of critical care after ICH requires a randomised trial with clinical outcomes and quality of life assessments.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Spontaneous intracerebral haemorrhage, Modified Rankin scale (mRS) functional outcome, Critical care, Intensive care |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 22 Jun 2021 09:48 |
| Last Modified: | 18 Jan 2023 22:33 |
| DOI: | 10.1016/j.jns.2020.117141 |
| Open Access URL: | https://openresearch.lsbu.ac.uk/item/8qq77 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3127288 |
Dimensions
Dimensions
