Variability of ICU use in adult patients with minor traumatic intracranial hemorrhage

Daniel K. Nishijima, Jason S. Haukoos, Craig Newgard, Kristan Staudenmayer, Nathan White, David Slattery, Preston C. Maxim, Christopher A. Gee, Renee Y. Hsia, Joy A. Melnikow, James F. Holmes

Research output: Contribution to journalArticle

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Abstract

Study objective: Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables. Methods: A structured, historical cohort study of adult patients (aged 18 years and older) with minor traumatic intracranial hemorrhage was conducted within a consortium of 8 Level I trauma centers in the western United States from January 2005 to June 2010. The study population included patients with minor traumatic intracranial hemorrhage, defined as an emergency department (ED) Glasgow Coma Scale (GCS) score of 15 (normal mental status) and an Injury Severity Score less than 16 (no other major organ injury). The primary outcome measure was initial ICU admission. The secondary outcome measure was a critical care intervention during hospitalization. Critical care interventions included mechanical ventilation, neurosurgical intervention, transfusion of blood products, vasopressor or inotrope administration, and invasive hemodynamic monitoring. ED disposition and the proportion of ICU patients not receiving a critical care intervention were compared across sites with descriptive statistics. The association between ICU admission and predetermined independent variables was analyzed with multivariable regression. Results: Among 11,240 adult patients with traumatic intracranial hemorrhage, 1,412 (13%) had minor traumatic intracranial hemorrhage and complete ED disposition data (mean age 48 years; SD 20 years). ICU use within this cohort across sites ranged from 50% to 97%. Overall, 847 of 888 patients (95%) with minor traumatic intracranial hemorrhage who were admitted to the ICU did not receive a critical care intervention during hospitalization (range between sites 80% to 100%). Three of 524 (0.6%) patients discharged home or admitted to the observation unit or ward received a critical care intervention. After controlling for severity of injury (age, blood pressure, and Injury Severity Score), study site was independently associated with ICU admission (odds ratios ranged from 1.5 to 30; overall effect P

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume61
Issue number5
DOIs
StatePublished - May 2013

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Traumatic Intracranial Hemorrhage
Critical Care
Hospital Emergency Service
Injury Severity Score
Hospitalization
Trauma Centers
Outcome Assessment (Health Care)
Glasgow Coma Scale
Multiple Trauma
Wounds and Injuries
Artificial Respiration
Blood Transfusion
Cohort Studies
Hemodynamics
Odds Ratio

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Variability of ICU use in adult patients with minor traumatic intracranial hemorrhage. / Nishijima, Daniel K.; Haukoos, Jason S.; Newgard, Craig; Staudenmayer, Kristan; White, Nathan; Slattery, David; Maxim, Preston C.; Gee, Christopher A.; Hsia, Renee Y.; Melnikow, Joy A.; Holmes, James F.

In: Annals of Emergency Medicine, Vol. 61, No. 5, 05.2013.

Research output: Contribution to journalArticle

Nishijima, DK, Haukoos, JS, Newgard, C, Staudenmayer, K, White, N, Slattery, D, Maxim, PC, Gee, CA, Hsia, RY, Melnikow, JA & Holmes, JF 2013, 'Variability of ICU use in adult patients with minor traumatic intracranial hemorrhage', Annals of Emergency Medicine, vol. 61, no. 5. https://doi.org/10.1016/j.annemergmed.2012.08.024
Nishijima, Daniel K. ; Haukoos, Jason S. ; Newgard, Craig ; Staudenmayer, Kristan ; White, Nathan ; Slattery, David ; Maxim, Preston C. ; Gee, Christopher A. ; Hsia, Renee Y. ; Melnikow, Joy A. ; Holmes, James F. / Variability of ICU use in adult patients with minor traumatic intracranial hemorrhage. In: Annals of Emergency Medicine. 2013 ; Vol. 61, No. 5.
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abstract = "Study objective: Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables. Methods: A structured, historical cohort study of adult patients (aged 18 years and older) with minor traumatic intracranial hemorrhage was conducted within a consortium of 8 Level I trauma centers in the western United States from January 2005 to June 2010. The study population included patients with minor traumatic intracranial hemorrhage, defined as an emergency department (ED) Glasgow Coma Scale (GCS) score of 15 (normal mental status) and an Injury Severity Score less than 16 (no other major organ injury). The primary outcome measure was initial ICU admission. The secondary outcome measure was a critical care intervention during hospitalization. Critical care interventions included mechanical ventilation, neurosurgical intervention, transfusion of blood products, vasopressor or inotrope administration, and invasive hemodynamic monitoring. ED disposition and the proportion of ICU patients not receiving a critical care intervention were compared across sites with descriptive statistics. The association between ICU admission and predetermined independent variables was analyzed with multivariable regression. Results: Among 11,240 adult patients with traumatic intracranial hemorrhage, 1,412 (13{\%}) had minor traumatic intracranial hemorrhage and complete ED disposition data (mean age 48 years; SD 20 years). ICU use within this cohort across sites ranged from 50{\%} to 97{\%}. Overall, 847 of 888 patients (95{\%}) with minor traumatic intracranial hemorrhage who were admitted to the ICU did not receive a critical care intervention during hospitalization (range between sites 80{\%} to 100{\%}). Three of 524 (0.6{\%}) patients discharged home or admitted to the observation unit or ward received a critical care intervention. After controlling for severity of injury (age, blood pressure, and Injury Severity Score), study site was independently associated with ICU admission (odds ratios ranged from 1.5 to 30; overall effect P",
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