Abstract Details

Title Early Neurological Improvement Can Reduce Intensive Care Unit Length of Stay in Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-008

Background aSAH is often accompanied by extended LOS in the ICU, at tremendous cost to both the hospital system and the patient. Thorough understanding of predictors for LOS could mitigate this issue.

Objective To identify novel predictors for intensive care unit (ICU) length of stay (LOS) in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Design/Methods We performed a retrospective study of a cohort of consecutive patients with aSAH admitted to an academic referral center from 2016 to 2021. Multiple linear regression was performed in survivors to identify predictors for ICU LOS among factors present on admission and those related to hospital course.

Results In a cohort of 306 patients with confirmed aSAH, mean age was 57 years (SD 13.7), 61% were female and 70% were white. ICU LOS was longer for survivors (median 19 days, IQR 14-25) than for non-survivors (median 5 days, IQR 2-8; p<0.001). For survivors (n=210), admission-related factors including Hunt and Hess grades 4 or 5 (4 additional days, 95% CI 0.5-7.5; p=0.027), hydrocephalus with external ventricular drain requirement (9.2 additional days, 95% CI 5.7-12.8; p<0.001), and coagulopathy (3.2 additional days, 95% CI 0.9-6.2; p=0.03) were associated with longer ICU LOS; however, early neurological improvement (defined as decrease in Hunt and Hess grades within first 3 days of admission) was associated with shorter ICU LOS (5.4 fewer days, 95% CI 2.7-8.5; p=0.001). Among hospital-related factors, symptomatic vasospasm (3.2 additional days, 95% CI 1.9-6.5; p=0.016), pneumonia (5.7 additional days, 95% CI 3.5-9.4; p=0.001), and laryngeal edema (4.3 additional days, 95% CI 0.7-7.8; p<0.001) were associated with prolonged ICU LOS. Laboratory values from admission and past medical history were not predictive for ICU LOS.

Conclusions Early neurological improvement can be associated with shorter ICU LOS which underscores the importance of early aggressive treatment measures in patients with aSAH.

Authors/Disclosures
Ryan Snow (Warren Alpert Medical School of Brown University) PRESENTER	Mr. Snow has nothing to disclose.
Alizeh Shamshad	Ms. Shamshad has nothing to disclose.
Alexandra Helliwell	Ms. Helliwell has nothing to disclose.
Nicholas S. Potter, MD, PhD (Rhode Island Hospital)	Dr. Potter has nothing to disclose.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Jesse Menville	Ms. Menville has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	Dr. Stretz has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has nothing to disclose.