Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer, Andreas H.; Zygun, David

doi:10.1007/s12630-013-0001-0

Cited by 27 publications

(16 citation statements)

References 69 publications

(71 reference statements)

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“…A discharge disposition to home and inpatient acute rehabilitation was classified as a good outcome, while discharge to a skilled nursing, long‐term acute care facilities and death were classified as poor outcome. Previous studies have demonstrated and validated the discharge disposition as an outcome measure for ICH . Body mass index (BMI) and obesity classification – Patients with ICH were admitted to the neuroscience intensive care unit at Ochsner Medical Center, New Orleans, LA. On admission, the patients were weighed and their height measured using a flexible tape by the nursing staff.…”

Section: Methodsmentioning

confidence: 99%

Racial differences in intracerebral haemorrhage outcomes in patients with obesity

Iwuchukwu

Mahale

Ryder

et al. 2018

Obesity Science & Practice

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SummaryObjectiveThis study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes.MethodsThe Get with the guideline‐Stroke database was queried for all admitted patients with spontaneous ICH. Secondary causes of ICH were excluded. Body mass index (BMI) was classified using the Center for Disease Control guidelines. Race was classified as White or non‐White. Demographics, clinical, imaging data were retrieved. Outcome measures were hematoma expansion at 24 h and discharge disposition.ResultsA total of 428 patients were included in our analysis. Female gender, past history of congestive heart failure, diabetes mellitus, HbA1c, blood pressure, ICH volume, ICH location, intraventricular haemorrhage and hospital length of stay deferred across BMI categories. On multivariate analysis, along with obese categories, age, ICH location and ICH volume were independent predictors of poor outcomes (hematoma expansion and poor discharge disposition). After adjusting for these variables, obesity remained a predictor of poor disposition outcome compared with normal and overweight subjects; Normal vs. Obese OR 0.26 CI 0.115–0.593 p = 0.0014; Obese vs. Overweight OR 3.79 CI 1.68–8.52 p = 0.0013. Nonetheless, obesity did not influence hematoma expansion. Overall, BMI‐race classification did not influence outcomes. However, among non‐Whites, the obese category had higher odds of a poor disposition outcome than normal (OR 6.84 CI 2.12–22.22 p = 0.0013) or overweight (OR 8.45 CI 2.6–27.49 p = 0.0004) categories.ConclusionAn obesity paradox in ICH was not observed in our cohort. In the non‐White population, patients with obesity were likely to be associated with poor disposition outcome. Similar findings were not observed in White population.

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Section: Methodsmentioning

confidence: 99%

Racial differences in intracerebral haemorrhage outcomes in patients with obesity

Iwuchukwu

Mahale

Ryder

et al. 2018

Obesity Science & Practice

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“…Numerous changes have been instituted in our region, which have been associated with improvements in mortality and neurologic recovery. 9 Examples include the development of a regional protocol for the care of patients with traumatic brain injury, the presence of fellowship-trained neurocritical care specialists, and the selective use of decompressive craniectomy. [28][29][30] Comparable resources to those in our region exist at other Canadian academic medical centres.…”

Section: Main Findingsmentioning

confidence: 99%

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Kramer

Zygun

Doig

et al. 2013

CMAJ

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“…This distinction is important because isolated severe TBI has distinct pathophysiology from TBI in the setting of multisystem trauma [ 4 ]; for example, early hypotension after multisystem trauma is generally secondary to hemorrhagic shock [ 5 ], while the etiology of hypotension after isolated TBI is less clear [ 6 ]. In addition, the largest of the prior studies of risk factors for mortality after severe TBI, based on the National Traumatic Coma Data Bank, used prospective data collected from patients with polytrauma and over a period between 1983 and 1988 [ 3 ], and advances have been made in TBI-specific surgical care as well as intensive care unit (ICU) care since this time period [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Demographic and clinical risk factors associated with hospital mortality after isolated severe traumatic brain injury: a cohort study

et al. 2015

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BackgroundTraumatic brain injury (TBI) is a major public health problem and a leading cause of death worldwide. A paucity of literature exists on risk factors for mortality in isolated severe TBI, a condition that is distinct from severe TBI in the setting of multisystem trauma. We determined risk factors for in-hospital mortality in this patient population.MethodsWe conducted a retrospective cohort study using data from the National Trauma Databank from 2008–2012 to study all patients admitted with a diagnosis of severe TBI, excluding children, patients with non-isolated TBI, transfers, and hospitalization <48 h. We used multivariable Poisson regression to analyze the association between demographic, clinical, and facility-level characteristics and in-hospital mortality.ResultsA total of 41,590 patients were included in our analysis. The cumulative incidence of in-hospital mortality was 10.2 %. In multivariable analysis, older age (RR 3.92, 95 % CI 3.54–4.34), male gender (RR 1.17, 95 % CI 1.09–1.25), admission hypotension (RR 1.83, 95 % CI 1.61–2.09), the need for mechanical ventilation (RR 4.18, 95 % CI 3.64–4.80), higher injury severity score (RR 1.86, 95 % CI 1.41–2.45), and poor initial neurologic grade (RR 3.06, 95 % CI 2.74–3.43) were associated with a higher risk for mortality.ConclusionsAdmission hypotension and the need for mechanical ventilation were possible modifiable risk factors associated with increased in-hospital mortality following isolated severe TBI. Although risk factors for mortality are similar in isolated and non-isolated TBI, the underlying etiologies for hypotension and respiratory failure are likely different in both conditions and require further exploration.

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Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Cited by 27 publications

References 69 publications

Racial differences in intracerebral haemorrhage outcomes in patients with obesity

Racial differences in intracerebral haemorrhage outcomes in patients with obesity

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Demographic and clinical risk factors associated with hospital mortality after isolated severe traumatic brain injury: a cohort study

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