Abstract Details

Title Decreased Odds for Vasospasm Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage After Transitioning from Neurosurgery-Led Care to a Neurology-Led Multidisciplinary Approach

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-046

Objective To describe differences in outcomes of patients with aneurysmal subarachnoid hemorrhages (aSAH) after a transition from a neurosurgery-led intensive care unit (ICU) to neurology-led multidisciplinary care in the neuro-critical care unit (NCCU).

Background Few studies exist that compare management approaches for aSAH. The limited research on aSAH assessed the efficacy of neuro-intensivist-led care on outcomes but no prior studies have compared the number of trips to interventional radiology (IR) for vasospasm treatment by management approach in aSAH patients.

Design/Methods We included patients (>18) with aSAHs from 1/16-8/16 (pre-group) and from 3/17-11/17 (post-group). Pre-group care was led by a neurosurgeon. Post-group care included a neurologist, a pulmonary intensivist, a neurocritical care clinical nurse specialist, and a neurosurgeon. A euvolemia protocol was initiated for post-group care. The primary outcome was number of trips to interventional radiology (IR) for vasospasm treatment. Secondary outcomes were: vasospasm, mortality, mRS, and ischemic stroke. Data were analyzed using univariate analyses and multivariable ordinal logistic regression.

Results There were 99 patients with an aSAH included; 50 were in the pre-group and 49 were in the post-group. On average, patients in the post-group were 7 years older than the pre-group (p=0.05); there were no other significantly different demographic or clinical characteristics. The post-group was 62% less likely to have a higher number of trips to IR for vasospasm treatment, when compared to the pre-group, p<0.001. After adjustment, there were no significant differences between groups in any other outcome.

Conclusions In patients with aSAH, the neurology-led multidisciplinary care in the NCCU decreased the odds of repeated procedures for vasospasm treatment. Other outcomes maintained comparable to the prior neurosurgical-led care in the ICU. This may reduce the financial burden of hospitalization and lower utilization of scarce hospital resources. The neurology-led multidisciplinary care could be more cost-effective than the neurosurgical-led care.

Authors/Disclosures
Russell E. Bartt, MD, FAAN (Blue Sky Neurosciences) PRESENTER	Dr. Bartt has nothing to disclose.
Stephanie Jarvis	Stephanie Jarvis has nothing to disclose.
	No disclosure on file
Benjamin Atchie	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Alicia E. Bennett, DO (CarePoint HC)	Dr. Bennett has nothing to disclose.
Jeffrey C. Wagner, MD (Carepoint HC)	Dr. Wagner has nothing to disclose.
Alessandro Orlando, MPH (Trauma Research)	No disclosure on file
David Bar-Or	David Bar-Or has received intellectual property interests from a discovery or technology relating to health care.

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