Abstract Details

Title Rate of Utilization and Determination of Withdrawal of Care among Subarachnoid Hemorrhage Patients in United States

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 183

Objective

Background BACKGROUND: The use of "withdrawal of care" and impact upon outcomes among patients with subarachnoid hemorrhage is not well studied.

Design/Methods DESIGN/METHODS: We determined the frequency of "withdrawal of care" and compared the demographic, clinical characteristics, and in-hospital outcomes among subarachnoid hemorrhage patients stratified by use of "withdrawal of care".

Results RESULTS: "Withdrawal of care" during hospitalization was instituted in 8912 (3.4%) of the 257155 subarachnoid hemorrhage patients. The mean age [±standard deviation] of the patients who underwent "withdrawal of care" was significantly higher (70±16 years versus 57±17, p<0.001). In the stepwise logistic regression, women (odds ratio [OR] 1.2, 95% confidence interval [1.1-1.4]), presence of renal failure (OR 1.6, 95% CI 1.2-1.9), and intracerebral hemorrhage (OR 2.0, 95% CI 1.7-2.4) were significant predictors of "withdrawal of care" among subarachnoid hemorrhage patients. The rate of utilization of both endovascular (12% versus 19%, p<0.001) and surgical (9% versus 21%, p<0.001) were significantly lower among patients with "withdrawal of care". The rate of intubation and mechanical ventilation were significantly higher among patients who underwent "withdrawal of care". In-hospital mortality (80% versus 21%, p=<0.0001) was significantly higher but mean hospitalization charges ($82170 ± 125787 versus $124456±148956, p<0.001) and length of stay (6±8.8 versus 12±13.8 days, p<0.0001) were significantly lower among those with "withdrawal of care".

Conclusions CONCLUSIONS: While "withdrawal of care" was effective in limiting hospital charges and resource utilization, caution is needed to avoid disproportionately high mortality. The prominent relationship between "withdrawal of care" and gender and race/ethnicity of patients raise concerns that factors other than severity of disease influence decision making.

Authors/Disclosures
Hamza I. Maqsood, MD (Dept of Neurology) PRESENTER	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
	No disclosure on file
	No disclosure on file
Mollie Baird	No disclosure on file

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