Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage
Background Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications. Methods A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (IC...
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| Veröffentlicht in: | Neurocritical care 2012-12, Vol.17 (3), p.324-333 |
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| description | Background
Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications.
Methods
A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and subdural hemorrhage (SDH), admitted to the neuro-ICU at a tertiary-care academic hospital. Admission demographics, complications and 3-month functional outcomes were compared between directly admitted and transferred patients. The effect of transfer time on complications and outcomes was assessed.
Results
Of 257 total patients, 120 (47%) were transferred and 137 (53%) were directly admitted. About 86 (34%) had SAH, 80 (31%) had ICH and 91 (35%) had SDH. The median transfer time was 190 min (46–1,446). Transferred patients were significantly less educated, less likely to be insured and more frequently had SAH as a diagnosis than directly admitted patients (all
P
|
| doi_str_mv | 10.1007/s12028-012-9679-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1221128571</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1221128571</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-d737cc925d1ce45561eb47549cd8ee8739f8a5bd3fe94af9ef6176dbc68879b23</originalsourceid><addsrcrecordid>eNp1kE1LxDAURYMofoz-ADdScOOmmpe0TbOUQZ0BwY2uXIQ0fdFK29SkXTi_3pTxAwRXCeTcm_cOIadAL4FScRWAUVamFFgqCyHTzQ45hDwvUioL2J3vGaSF5PyAHIXwRikTUuT75IAxDsA4PyTP627QZkycTdb9iP7VhaEZdZs8et0Hiz5xfbJ03dA2Ro-N60Oi-zp5mEbjOkyubczMSa9NDDQxuMLOef-qX_CY7FndBjz5Ohfk6fbmcblK7x_u1svr-9RkkI9pLbgwRrK8BoNZHB-wykSeSVOXiKXg0pY6r2puUWbaSrQFiKKuTFGWQlaML8jFtnfw7n3CMKquCQbbVvfopqCAsbhtmQuI6Pkf9M1Nvo_TKSajTFZSPlOwpYx3IXi0avBNp_2HAqpm82prXkXzajavNjFz9tU8VR3WP4lv1RFgWyDEp_4F_e_X_7d-AgXqjx0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2920228031</pqid></control><display><type>article</type><title>Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage</title><source>MEDLINE</source><source>ProQuest Central (Alumni Edition)</source><source>ProQuest Central UK/Ireland</source><source>SpringerLink Journals - AutoHoldings</source><source>ProQuest Central</source><creator>Catalano, Ashley R. ; Winn, H. R. ; Gordon, Errol ; Frontera, Jennifer A.</creator><creatorcontrib>Catalano, Ashley R. ; Winn, H. R. ; Gordon, Errol ; Frontera, Jennifer A.</creatorcontrib><description>Background
Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications.
Methods
A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and subdural hemorrhage (SDH), admitted to the neuro-ICU at a tertiary-care academic hospital. Admission demographics, complications and 3-month functional outcomes were compared between directly admitted and transferred patients. The effect of transfer time on complications and outcomes was assessed.
Results
Of 257 total patients, 120 (47%) were transferred and 137 (53%) were directly admitted. About 86 (34%) had SAH, 80 (31%) had ICH and 91 (35%) had SDH. The median transfer time was 190 min (46–1,446). Transferred patients were significantly less educated, less likely to be insured and more frequently had SAH as a diagnosis than directly admitted patients (all
P
< 0.05), though admission neurological and cognitive status was similar. Complications did not differ between transferred and directly admitted patients; however, among transferred patients, longer transfer time was associated with aneurysm rebleed (7.3 vs. 1.8%,
P
= 0.007) and tracheostomy (20 vs. 17.5%,
P
= 0.013). In multivariate analysis, after adjusting for other predictors, transferred patients had worse cognitive outcome at 3-months (adjusted OR 12.4, 95% CI 1.2–125.2,
P
= 0.033) compared to direct admits, though there were no differences in death, disability or length of stay (LOS).
Conclusions
Transferred patients had similar rates of death, disability and LOS as directly admitted patients, though worse 3-month cognitive outcomes. Prolonged time to interhospital transfer was associated with an increased risk of aneurysm rerupture and tracheostomy.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-012-9679-z</identifier><identifier>PMID: 22311233</identifier><language>eng</language><publisher>New York: Humana Press Inc</publisher><subject><![CDATA[Activities of daily living ; Adult ; Aged ; Aged, 80 and over ; Clinical outcomes ; Coma ; Critical Care Medicine ; Critical Illness - mortality ; Disability Evaluation ; Ethnicity ; Female ; Hematoma, Subdural - mortality ; Hematoma, Subdural - rehabilitation ; Hematoma, Subdural - therapy ; Hemorrhage ; Hospital Mortality ; Hospitals ; Humans ; Incidence ; Intensive ; Intensive care ; Intensive Care Units - statistics & numerical data ; Internal Medicine ; Intracranial Hemorrhages - mortality ; Intracranial Hemorrhages - rehabilitation ; Intracranial Hemorrhages - therapy ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurology ; Neurosciences ; Nonparametric statistics ; Original Article ; Ostomy ; Outcome Assessment (Health Care) - statistics & numerical data ; Patient Transfer - statistics & numerical data ; Patients ; Prospective Studies ; Regression analysis ; Rehabilitation ; Risk Factors ; Subarachnoid Hemorrhage - mortality ; Subarachnoid Hemorrhage - rehabilitation ; Subarachnoid Hemorrhage - therapy ; Tertiary Care Centers - statistics & numerical data ; Trauma ; Variables ; Ventilators ; Young Adult]]></subject><ispartof>Neurocritical care, 2012-12, Vol.17 (3), p.324-333</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>Springer Science+Business Media, LLC 2012.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-d737cc925d1ce45561eb47549cd8ee8739f8a5bd3fe94af9ef6176dbc68879b23</citedby><cites>FETCH-LOGICAL-c415t-d737cc925d1ce45561eb47549cd8ee8739f8a5bd3fe94af9ef6176dbc68879b23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-012-9679-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2920228031?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,21369,21370,27905,27906,33511,33512,33725,33726,41469,42538,43640,43786,51300,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22311233$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Catalano, Ashley R.</creatorcontrib><creatorcontrib>Winn, H. R.</creatorcontrib><creatorcontrib>Gordon, Errol</creatorcontrib><creatorcontrib>Frontera, Jennifer A.</creatorcontrib><title>Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Background
Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications.
Methods
A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and subdural hemorrhage (SDH), admitted to the neuro-ICU at a tertiary-care academic hospital. Admission demographics, complications and 3-month functional outcomes were compared between directly admitted and transferred patients. The effect of transfer time on complications and outcomes was assessed.
Results
Of 257 total patients, 120 (47%) were transferred and 137 (53%) were directly admitted. About 86 (34%) had SAH, 80 (31%) had ICH and 91 (35%) had SDH. The median transfer time was 190 min (46–1,446). Transferred patients were significantly less educated, less likely to be insured and more frequently had SAH as a diagnosis than directly admitted patients (all
P
< 0.05), though admission neurological and cognitive status was similar. Complications did not differ between transferred and directly admitted patients; however, among transferred patients, longer transfer time was associated with aneurysm rebleed (7.3 vs. 1.8%,
P
= 0.007) and tracheostomy (20 vs. 17.5%,
P
= 0.013). In multivariate analysis, after adjusting for other predictors, transferred patients had worse cognitive outcome at 3-months (adjusted OR 12.4, 95% CI 1.2–125.2,
P
= 0.033) compared to direct admits, though there were no differences in death, disability or length of stay (LOS).
Conclusions
Transferred patients had similar rates of death, disability and LOS as directly admitted patients, though worse 3-month cognitive outcomes. Prolonged time to interhospital transfer was associated with an increased risk of aneurysm rerupture and tracheostomy.</description><subject>Activities of daily living</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Clinical outcomes</subject><subject>Coma</subject><subject>Critical Care Medicine</subject><subject>Critical Illness - mortality</subject><subject>Disability Evaluation</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Hematoma, Subdural - mortality</subject><subject>Hematoma, Subdural - rehabilitation</subject><subject>Hematoma, Subdural - therapy</subject><subject>Hemorrhage</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Internal Medicine</subject><subject>Intracranial Hemorrhages - mortality</subject><subject>Intracranial Hemorrhages - rehabilitation</subject><subject>Intracranial Hemorrhages - therapy</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Nonparametric statistics</subject><subject>Original Article</subject><subject>Ostomy</subject><subject>Outcome Assessment (Health Care) - statistics & numerical data</subject><subject>Patient Transfer - statistics & numerical data</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Regression analysis</subject><subject>Rehabilitation</subject><subject>Risk Factors</subject><subject>Subarachnoid Hemorrhage - mortality</subject><subject>Subarachnoid Hemorrhage - rehabilitation</subject><subject>Subarachnoid Hemorrhage - therapy</subject><subject>Tertiary Care Centers - statistics & numerical data</subject><subject>Trauma</subject><subject>Variables</subject><subject>Ventilators</subject><subject>Young Adult</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LxDAURYMofoz-ADdScOOmmpe0TbOUQZ0BwY2uXIQ0fdFK29SkXTi_3pTxAwRXCeTcm_cOIadAL4FScRWAUVamFFgqCyHTzQ45hDwvUioL2J3vGaSF5PyAHIXwRikTUuT75IAxDsA4PyTP627QZkycTdb9iP7VhaEZdZs8et0Hiz5xfbJ03dA2Ro-N60Oi-zp5mEbjOkyubczMSa9NDDQxuMLOef-qX_CY7FndBjz5Ohfk6fbmcblK7x_u1svr-9RkkI9pLbgwRrK8BoNZHB-wykSeSVOXiKXg0pY6r2puUWbaSrQFiKKuTFGWQlaML8jFtnfw7n3CMKquCQbbVvfopqCAsbhtmQuI6Pkf9M1Nvo_TKSajTFZSPlOwpYx3IXi0avBNp_2HAqpm82prXkXzajavNjFz9tU8VR3WP4lv1RFgWyDEp_4F_e_X_7d-AgXqjx0</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Catalano, Ashley R.</creator><creator>Winn, H. R.</creator><creator>Gordon, Errol</creator><creator>Frontera, Jennifer A.</creator><general>Humana Press Inc</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20121201</creationdate><title>Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage</title><author>Catalano, Ashley R. ; Winn, H. R. ; Gordon, Errol ; Frontera, Jennifer A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-d737cc925d1ce45561eb47549cd8ee8739f8a5bd3fe94af9ef6176dbc68879b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Activities of daily living</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clinical outcomes</topic><topic>Coma</topic><topic>Critical Care Medicine</topic><topic>Critical Illness - mortality</topic><topic>Disability Evaluation</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Hematoma, Subdural - mortality</topic><topic>Hematoma, Subdural - rehabilitation</topic><topic>Hematoma, Subdural - therapy</topic><topic>Hemorrhage</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Internal Medicine</topic><topic>Intracranial Hemorrhages - mortality</topic><topic>Intracranial Hemorrhages - rehabilitation</topic><topic>Intracranial Hemorrhages - therapy</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Neurosciences</topic><topic>Nonparametric statistics</topic><topic>Original Article</topic><topic>Ostomy</topic><topic>Outcome Assessment (Health Care) - statistics & numerical data</topic><topic>Patient Transfer - statistics & numerical data</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Regression analysis</topic><topic>Rehabilitation</topic><topic>Risk Factors</topic><topic>Subarachnoid Hemorrhage - mortality</topic><topic>Subarachnoid Hemorrhage - rehabilitation</topic><topic>Subarachnoid Hemorrhage - therapy</topic><topic>Tertiary Care Centers - statistics & numerical data</topic><topic>Trauma</topic><topic>Variables</topic><topic>Ventilators</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Catalano, Ashley R.</creatorcontrib><creatorcontrib>Winn, H. R.</creatorcontrib><creatorcontrib>Gordon, Errol</creatorcontrib><creatorcontrib>Frontera, Jennifer A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Catalano, Ashley R.</au><au>Winn, H. R.</au><au>Gordon, Errol</au><au>Frontera, Jennifer A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>17</volume><issue>3</issue><spage>324</spage><epage>333</epage><pages>324-333</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Background
Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications.
Methods
A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and subdural hemorrhage (SDH), admitted to the neuro-ICU at a tertiary-care academic hospital. Admission demographics, complications and 3-month functional outcomes were compared between directly admitted and transferred patients. The effect of transfer time on complications and outcomes was assessed.
Results
Of 257 total patients, 120 (47%) were transferred and 137 (53%) were directly admitted. About 86 (34%) had SAH, 80 (31%) had ICH and 91 (35%) had SDH. The median transfer time was 190 min (46–1,446). Transferred patients were significantly less educated, less likely to be insured and more frequently had SAH as a diagnosis than directly admitted patients (all
P
< 0.05), though admission neurological and cognitive status was similar. Complications did not differ between transferred and directly admitted patients; however, among transferred patients, longer transfer time was associated with aneurysm rebleed (7.3 vs. 1.8%,
P
= 0.007) and tracheostomy (20 vs. 17.5%,
P
= 0.013). In multivariate analysis, after adjusting for other predictors, transferred patients had worse cognitive outcome at 3-months (adjusted OR 12.4, 95% CI 1.2–125.2,
P
= 0.033) compared to direct admits, though there were no differences in death, disability or length of stay (LOS).
Conclusions
Transferred patients had similar rates of death, disability and LOS as directly admitted patients, though worse 3-month cognitive outcomes. Prolonged time to interhospital transfer was associated with an increased risk of aneurysm rerupture and tracheostomy.</abstract><cop>New York</cop><pub>Humana Press Inc</pub><pmid>22311233</pmid><doi>10.1007/s12028-012-9679-z</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Activities of daily living Adult Aged Aged, 80 and over Clinical outcomes Coma Critical Care Medicine Critical Illness - mortality Disability Evaluation Ethnicity Female Hematoma, Subdural - mortality Hematoma, Subdural - rehabilitation Hematoma, Subdural - therapy Hemorrhage Hospital Mortality Hospitals Humans Incidence Intensive Intensive care Intensive Care Units - statistics & numerical data Internal Medicine Intracranial Hemorrhages - mortality Intracranial Hemorrhages - rehabilitation Intracranial Hemorrhages - therapy Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Middle Aged Neurology Neurosciences Nonparametric statistics Original Article Ostomy Outcome Assessment (Health Care) - statistics & numerical data Patient Transfer - statistics & numerical data Patients Prospective Studies Regression analysis Rehabilitation Risk Factors Subarachnoid Hemorrhage - mortality Subarachnoid Hemorrhage - rehabilitation Subarachnoid Hemorrhage - therapy Tertiary Care Centers - statistics & numerical data Trauma Variables Ventilators Young Adult |
| title | Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage |
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