Decreased Odds for Vasospasm Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage after Transitioning from Neurosurgery Led Care to a Neurology Led Multidisciplinary Approach.

Division

Continental

Hospital

Swedish Medical Center

Document Type

Manuscript

Publication Date

5-1-2019

Keywords

multidisciplinary care, vasospasm, subarachnoid hemorrhages, neurosurgery, NCCU

Disciplines

Medicine and Health Sciences | Neurology

Abstract

Introduction: The limited research on the management of aneurysmal subarachnoid hemorrhages (aSAHs) has not assessed the efficacy of neurology-led care. Our objective was to describe aSAH patients' outcomes after transitioning from a neurosurgery-led intensive care unit (ICU) to a neurology-led multidisciplinary care neurocritical care unit (NCCU). The study hypothesis was that the neurology-led multidisciplinary care would improve patient outcomes.

Methods: This was a retrospective cohort study. We included patients (≥ 18) with aSAHs from 1/16 to 8/16 (pregroup) and from 3/17 to 11/17 (postgroup). The pregroup care was led by a neurosurgeon. The postgroup care included a neurologist, a pulmonary intensivist, a neurocritical care clinical nurse specialist, a neurosurgeon, and euvolemia protocol. The primary outcome was trips to interventional radiology (IR) for vasospasm treatment. Univariate analyses and multivariable ordinal logistic regression were used.

Results: There were 99 patients included: 50 in the pregroup and 49 in the postgroup. On average, postgroup patients were 7 years older than the pregroup (

Conclusions: In aSAH patients, the neurology-led multidisciplinary care in the NCCU decreased the odds of repeated procedures for vasospasm treatment. Neurology-led multidisciplinary care could be more cost-effective than the neurosurgical-led care.

Publisher or Conference

Journal of Vascular and Interventional Neurology

Link to Full Text

Share

COinS