Severe headache trajectory following aneurysmal subarachnoid hemorrhage: the association with lower sodium levels

Eisinger, Robert S.; Sorrentino, Zachary A.; Lucke‐Wold, Brandon; Zhou, Sonya E.; Barlow, Brooke; Hoh, Brian L.; Maciel, Carolina B.; Busl, Katharina M.

doi:10.1080/02699052.2022.2055146

Cited by 12 publications

(22 citation statements)

References 40 publications

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“…Other medications utilized, the mean dosage/day, and percentage of patients receiving the listed medication at any time during admission are listed (Table 2). Almost all patients received opioids (87.4%), A/B/C (95.8%), and acetaminophen separate from A/B/C (93.3%) during admission, with widely varied daily dosing depending on reported pain scores as found previously [14]. This acetaminophen is not included in that found within A/B/C…”

Section: Medication Characteristicsmentioning

confidence: 76%

“…There were 302 patients with aneurysmal SAH identi ed within the examined timeframe; 175 were excluded for inability to verbalize pain scale scores for > 4 days [14]. The demographics of the patients are summarized in Table 1; the cohort comprised 119 patients with mean age 61.7 ± 15.2 years and 89 (74.7%) females, of whom 32 (26.9%) experienced DCI during admission.…”

Section: Cohort Characteristics and Relation To DCImentioning

confidence: 99%

“…Patients were excluded if they could not verbally report pain scores using the 11-point numeric rating scale for 4 or more days during admission. Ability to verbalize pain was needed for the original aim of this database to evaluate headache pain [14], and also to allow for study of varied analgesic medication dosages as this cohort of patients was able to request PRN medications for pain alleviation. All neuro-ICU patients received guideline-recommended post SAH care [1,15] including nimodipine, blood pressure control, short-term seizure prophylaxis, and other supportive measures.…”

Section: Study Design Setting and Patient Selectionmentioning

confidence: 99%

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Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

Sorrentino

Eisinger

Maciel

et al. 2022

Preprint

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Background Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) recovery may be hampered by delayed cerebral ischemia (DCI). Herein, we sought to identify an association of DCI with frequently administered medications in the neurointensive care unit (neuro-ICU). Methods In this retrospective study, patients admitted to a tertiary care center neuro-ICU between 2012–2019 with aSAH who could verbalize pain intensity scores were included. Medication dosages and clinical characteristics were abstracted from the medical record. Both paired (within subjects) and unpaired (across subjects) non-parametric analyses were utilized to measure individual DCI risk for a given patient in relation to drug dosages. Results 119 patients were included; average age was 61.7 ± 15.2 (SD) years, 89 (74.7%) were female, and 32 (26.9%) experienced DCI during admission. Patients with DCI had longer length of stay (19.3 ± 7.4 vs 12.7 ± 5.3 days, p < 0.0001). The combination medication of acetaminophen 325 mg/butalbital 50 mg/caffeine 40 mg (A/B/C; Fioricet®) was associated with decreased DCI on paired (2.3 ± 2.0 vs 3.1 ± 1.9 tabs, p = 0.034) and unpaired analysis (1.84 ± 2.4 vs 2.6 ± 2.4 tabs, p < 0.001). No associations were found between DCI and opioids, dexamethasone, levetiracetam, or acetaminophen. Max and mean daily headache pain was not associated with DCI occurrence. Conclusion We identified a dose-response relationship between a commonly administered analgesic and DCI. A/B/C is associated with decreased DCI in this study both within and across subjects, while other medications are not associated with DCI.

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Section: Medication Characteristicsmentioning

confidence: 76%

Section: Cohort Characteristics and Relation To DCImentioning

confidence: 99%

Section: Study Design Setting and Patient Selectionmentioning

confidence: 99%

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Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

Sorrentino

Eisinger

Maciel

et al. 2022

Preprint

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“…Other factors of significance that warrant discussion include variability in management of post-SAH pain and headache ( 51 ) as well as elevated intracranial pressure (ICP) ( 52 ). Our ability to study these was limited due to limited availability of more granular inpatient data in the Vizient data-base, including patient-reported pain, behavioral pain scores, ICP recordings and related interventions.…”

Section: Discussionmentioning

confidence: 99%

Regional Variability in the Care and Outcomes of Subarachnoid Hemorrhage Patients in the United States

et al. 2022

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Background and ObjectivesRegional variability in subarachnoid hemorrhage (SAH) care is reported in physician surveys. We aimed to describe variability in SAH care using patient-level data and identify factors impacting hospital outcomes and regional variability in outcomes.MethodsA retrospective multi-center cross-sectional cohort study of consecutive non-traumatic SAH patients in the Vizient Clinical Data Base, between January 1st, 2009 and December 30th, 2018 was performed. Participating hospitals were divided into US regions: Northeast, Midwest, South, West. Regional demographics, co-morbidities, severity-of-illness, complications, interventions and discharge outcomes were compared. Multivariable logistic regression was performed to identify factors independently associated with primary outcomes: hospital mortality and poor discharge outcome. Poor discharge outcome was defined by the Nationwide Inpatient Sample-SAH Outcome Measure, an externally-validated outcome measure combining death, discharge disposition, tracheostomy and/or gastrostomy. Regional variability in the associations between care and outcomes were assessed by introducing an interaction term for US region into the models.ResultsOf 109,034 patients included, 24.3% were from Northeast, 24.9% Midwest, 34.9% South, 15.9% West. Mean (SD) age was 58.6 (15.6) years and 64,245 (58.9%) were female. In-hospital mortality occurred in 21,991 (20.2%) and 44,159 (40.5%) had poor discharge outcome. There was significant variability in severity-of-illness, co-morbidities, complications and interventions across US regions. Notable findings were higher prevalence of surgical clipping (18.8 vs. 11.6%), delayed cerebral ischemia (4.3 vs. 3.1%), seizures (16.5 vs. 14.8%), infections (18 vs. 14.7%), length of stay (mean [SD] days; 15.7 [19.2] vs. 14.1 [16.7]) and health-care direct costs (mean [SD] USD; 80,379 [98,999]. vs. 58,264 [74,430]) in the West when compared to other regions (all p < 0.0001). Variability in care was also associated with modest variability in hospital mortality and discharge outcome. Aneurysm repair, nimodipine use, later admission-year, endovascular rescue therapies reduced the odds for poor outcome. Age, severity-of-illness, co-morbidities, hospital complications, and vasopressor use increased those odds (c-statistic; mortality: 0.77; discharge outcome: 0.81). Regional interaction effect was significant for admission severity-of-illness, aneurysm-repair and nimodipine-use.DiscussionMultiple hospital-care factors impact SAH outcomes and significant variability in hospital-care and modest variability in discharge-outcomes exists across the US. Variability in SAH-severity, nimodipine-use and aneurysm-repair may drive variability in outcomes.

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“…Patients with elevated PBV may indicate impaired autonomic regulation of the brain and subsequent treatment (e.g., optimal- cerebral perfusion pressure (CPP) targeted therapy guided by intracranial pressure (ICP) monitoring) can be applied immediately to maintain a reasonable CPP and a stable CBF to avoid cerebral congestion or ischemia. Future studies with a larger patient population and long-term outcomes will be conducted to explore the diagnostic threshold for PBV so as to make more objective and accurate predictions, and guide clinical interventions in a timely manner ( 52 ). During the COVID-19 pandemic, not only was the coronavirus likely to worsen hypertension and make aneurysms more prone to rupture, but intensive care unit (ICU) resources were more strained, leaving patients more vulnerable ( 53 ).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Wen

Zhou

et al. 2022

Front. Neurol.

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PurposeAneurysmal subarachnoid hemorrhage (SAH) is accompanied by cerebral perfusion changes. We aimed to measure the parenchymal blood volume (PBV) maps acquired by C-arm flat-panel detector CT (FDCT) to assess the cerebral blood volume at an early stage in aneurysmal SAH and to explore the correlation with the outcomes at discharge.MethodsData of 66 patients with aneurysmal SAH who underwent FDCT PBV examination were retrospectively analyzed. The PBV of regions of interest, including the cortices of the bilateral frontal lobe, the parietal lobe, the occipital lobe, and the cerebral hemisphere, as well as the basal ganglia, were measured and quantitatively analyzed. The clinical and imaging data of the patients were also collected, and logistic regression analysis was performed to explore the correlation between the perfusion parameters and outcomes at discharge.ResultsThe favorable and poor outcomes at discharge were found in 37 (56.06%) and 29 (43.94%) patients, respectively. The whole-brain PBV was significantly correlated with the Hunt-Hess grades (p < 0.005) and the WFNSS grades (p < 0.005). The whole-brain PBV of the poor prognosis was significantly higher than that of the favorable prognosis (35.17 ± 7.66 vs. 29.78 ± 5.54, p < 0.005). The logistic regression analysis showed that the PBV of the parietal lobe at the bleeding side (OR = 1.10, 95%CI: 1.00–1.20, p = 0.04) was an independent risk factor predicting the short-term prognosis.ConclusionsParenchymal blood volume (PBV) maps could reflect the cerebral blood volume throughout the brain to characterize its perfusion status at an early stage in aneurysmal SAH. It enables a one-stop imaging evaluation and treatment in the same angio-suite and may serve as a reliable technique in clinical assessment of aneurysmal SAH.

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Severe headache trajectory following aneurysmal subarachnoid hemorrhage: the association with lower sodium levels

Cited by 12 publications

References 40 publications

Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

Regional Variability in the Care and Outcomes of Subarachnoid Hemorrhage Patients in the United States

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

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