Factors Associated with the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage: The Triage ICH Model.

KLAAS, J.P., S. BRAKSICK, J. MANDREKAR, Petra ŠEDOVÁ, M.F. BELLOLIO, A.A. RABINSTEIN and R.D. Jr. BROWN. Factors Associated with the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage: The Triage ICH Model. Neurocritical Care. Totowa: Humana Press, 2017, vol. 27, No 1, p. 75-81. ISSN 1541-6933. Available from: https://dx.doi.org/10.1007/s12028-016-0346-7.

Basic information

• Original name: Factors Associated with the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage: The Triage ICH Model.
• Authors: KLAAS, J.P. (840 United States of America), S. BRAKSICK (840 United States of America), J. MANDREKAR (840 United States of America), Petra ŠEDOVÁ (203 Czech Republic, guarantor, belonging to the institution), M.F. BELLOLIO (840 United States of America), A.A. RABINSTEIN (840 United States of America) and R.D. Jr. BROWN (840 United States of America).
• Edition: Neurocritical Care, Totowa, Humana Press, 2017, 1541-6933.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30218 General and internal medicine
• Country of publisher: United States of America
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 3.163
• RIV identification code: RIV/00216224:14110/17:00096138
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1007/s12028-016-0346-7
• UT WoS: 000406310200011
• Keywords in English: Intensive care; Intracerebral hemorrhage; Triage
• Tags: EL OK
• Tags: International impact, Reviewed

Abstract

Abstract BACKGROUND: Providing the correct level of care for patients with intracerebral hemorrhage (ICH) is crucial, but the level of care needed at initial presentation may not be clear. This study evaluated factors associated with admission to intensive care unit (ICU) level of care. METHODS: This is an observational study of all adult patients admitted to our institution with non-traumatic supratentorial ICH presenting within 72 h of symptom onset between 2009-2012 (derivation cohort) and 2005-2008 (validation cohort). Factors associated with neuroscience ICU admission were identified via logistic regression analysis, from which a triage model was derived, refined, and retrospectively validated. RESULTS: For the derivation cohort, 229 patients were included, of whom 70 patients (31 %) required ICU care. Predictors of neuroscience ICU admission were: younger age [odds ratio (OR) 0.94, 95 % CI 0.91-0.97; p = 0.0004], lower Full Outline of UnResponsiveness (FOUR) score (0.39, 0.28-0.54; p < 0.0001) or Glasgow Coma Scale (GCS) score (0.55, 0.45-0.67; p < 0.0001), and larger ICH volume (1.04, 1.03-1.06; p < 0.0001). The model was further refined with clinician input and the addition of intraventricular hemorrhage (IVH). GCS was chosen for the model rather than the FOUR score as it is more widely used. The proposed triage ICH model utilizes three variables: ICH volume 30 cc, GCS score <13, and IVH. The triage ICH model predicted the need for ICU admission with a sensitivity of 94.3 % in the derivation cohort [area under the curve (AUC) = 0.88; p < 0.001] and 97.8 % (AUC = 0.88) in the validation cohort. CONCLUSIONS: Presented are the derivation, refinement, and validation of the triage ICH model. This model requires prospective validation, but may be a useful tool to aid clinicians in determining the appropriate level of care at the time of initial presentation for a patient with a supratentorial ICH.