Association between critical care admission and 6-month functional outcome after spontaneous intracerebral haemorrhage

Journal article


Lernon, S, Schwarz, G, Wilson, D, Ambler, G, Goodwin, R, Shakeshaft, C, Cohen, H, Yousry, T, Salman, RA, Lip, GYH, Houlden, H, Brown, MM, Muir, KW, Jäger, HR, Terry, L and Werring, DJ (2020). Association between critical care admission and 6-month functional outcome after spontaneous intracerebral haemorrhage. Journal of the Neurological Sciences. 418, p. 117141. https://doi.org/10.1016/j.jns.2020.117141
AuthorsLernon, S, Schwarz, G, Wilson, D, Ambler, G, Goodwin, R, Shakeshaft, C, Cohen, H, Yousry, T, Salman, RA, Lip, GYH, Houlden, H, Brown, MM, Muir, KW, Jäger, HR, Terry, L and Werring, DJ
Abstract

Background. There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH).
Purpose. We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome.
Methods. 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.
Results. 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), and more often had intraventricular extension (p = 0.008). They also underwent neurosurgery more frequently (p<0.001) and had a higher proportion of patients with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034). In multivariable analysis, critical care maintained its association with a higher odds of poor functional outcome (adjusted OR 2.43 [95%CI 1.36-4.35], p=0.003).
Conclusions. Admission to critical care is associated with poor 6-month functional outcome after spontaneous ICH. Our findings provide prognostic information that can help guide critical care treatment decisions after ICH.

KeywordsSpontaneous intracerebral haemorrhage; Modified Rankin Scale (mRS) functional outcome; Critical Care; Intensive care
Year2020
JournalJournal of the Neurological Sciences
Journal citation418, p. 117141
PublisherElsevier BV
ISSN0022-510X
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jns.2020.117141
Publication dates
Online19 Sep 2020
Publication process dates
Accepted12 Sep 2020
Deposited24 Sep 2020
Accepted author manuscript
License
File Access Level
Open
Page range117141-117141
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