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

Authors
  • Bartt, Russell1, 2
  • Jarvis, Stephanie3
  • Cittadino, Lauren2
  • Atchie, Benjamin2
  • McCarthy, Kathryn2
  • van Vliet, Rebecca2
  • Bennett, Alicia1, 2
  • Wagner, Jeffrey1, 2
  • Orlando, Alessandro3
  • Bar-Or, David3
  • 1 Blue Sky Neurology, Swedish Medical Center.
  • 2 Neurology, Swedish Medical Center.
  • 3 Trauma Research.
Type
Published Article
Journal
Journal of vascular and interventional neurology
Publication Date
May 01, 2019
Volume
10
Issue
3
Pages
30–33
Identifiers
PMID: 31308868
Source
Medline
Language
English
License
Unknown

Abstract

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. 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. 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 (p = 0.05); no other demographic or clinical characteristics significantly differed. The 62% higher number of trips to IR for vasospasm treatment, when compared to the pregroup, p < 0.001. 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.

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