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Frequency, Risk Factors, and Outcomes of Unplanned Readmission to the Neurological Intensive Care Unit after Spontaneous Intracerebral Hemorrhage

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Abstract

Background

Unplanned readmission to the neurological intensive care unit (ICU) is an underinvestigated topic in patients admitted after spontaneous intracerebral hemorrhage (ICH). The purpose of this study is to investigate the frequency, clinical risk factors, and outcome of bounce back to the neurological ICU in a cohort of patients admitted after ICH.

Methods

This is a retrospective observational study inspecting bounce back to the neurological ICU in patients admitted with spontaneous ICH over an 8-year period. For each patient, demographics, medical history, clinical presentation, length of ICU stay, unplanned readmission to neurological ICU, cause of readmission, and mortality were reviewed. Bounce back to the neurological ICU was defined as an unplanned readmission to the neurological ICU from a general floor service during the same hospitalization. A multivariable analysis was used to define independent variables associated with bounce back to the neurological ICU as well as association between bounce back to the neurological ICU and mortality. The significance level was set at p < 0.05.

Results

A total of 221 patients were included. Among those, 20 (9%) had a bounce back to the neurological ICU. Respiratory complications (n = 11) was the most common reason for bounce back to the neurological ICU, followed by neurological (n = 5) and cardiological (n = 4) complications. In a multivariable logistic regression, location of hemorrhage in the basal ganglia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0–8.9, p = 0.03) and dysphagia at the time of transfer (OR: 3.9, 95% CI: 1.0–15.4, p = 0.04) were significantly associated with bounce back to the neurological ICU. After we controlled for ICH score, readmission to the ICU was also independently associated with higher mortality (OR: 14.1, 95% CI: 2.8–71.7, p < 0.01).

Conclusions

Bounce back to the neurological ICU is not an infrequent complication in patients with spontaneous ICH and is associated with higher hospital length of stay and mortality. We identified relevant and potentially modifiable risk factors associated with bounce back to the neurological ICU. Future prospective studies are necessary to develop patient-centered strategies that may improve transition from the neurological ICU to the general floor.

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Funding

This study received no external funding.

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Authors and Affiliations

  1. Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637-1470, USA

    Ruth Tangonan, Ronald Alvarado-Dyer, Faten El Ammar, Ruchit Kumbhani, Christos Lazaridis, Christopher Kramer, Fernando D. Goldenberg & Ali Mansour

  2. Southern Illinois Healthcare, Carbondale, IL, USA

    Andrea Loggini

  3. Southern Illinois University, Springfield, IL, USA

    Andrea Loggini

  4. Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Christos Lazaridis, Christopher Kramer, Fernando D. Goldenberg & Ali Mansour

Authors
  1. Ruth Tangonan
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  2. Ronald Alvarado-Dyer
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  3. Andrea Loggini
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  4. Faten El Ammar
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  5. Ruchit Kumbhani
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  6. Christos Lazaridis
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  7. Christopher Kramer
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  8. Fernando D. Goldenberg
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  9. Ali Mansour
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Contributions

AL was responsible for study concept and drafting the manuscript. RT and RAD were responsible for data collection and analysis and drafting the manuscript. AL was responsible for study design and data analysis. FDG, CL, and CK were responsible for critical revision of the manuscript. AM was responsible for the approval of the final version of the manuscript.

Corresponding author

Correspondence to Ali Mansour.

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The authors declare that they have nothing to disclose.

Ethical approval

This study was approved by the University of Chicago Medical Center Institutional Review Board and Ethics Standards Committee with a waiver of informed consent.

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Tangonan, R., Alvarado-Dyer, R., Loggini, A. et al. Frequency, Risk Factors, and Outcomes of Unplanned Readmission to the Neurological Intensive Care Unit after Spontaneous Intracerebral Hemorrhage. Neurocrit Care 37, 390–398 (2022). https://doi.org/10.1007/s12028-021-01415-w

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  • DOI: https://doi.org/10.1007/s12028-021-01415-w

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