共 25 条
Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes
被引:24
作者:
Chang, Tiffany R.
[1
,2
]
Kowalski, Robert G.
[3
]
Carhuapoma, J. Ricardo
[3
,4
,5
]
Tamargo, Rafael J.
[3
,5
]
Naval, Neeraj S.
[3
,4
,5
]
机构:
[1] Univ Texas Houston, Sch Med, Dept Neurosurg, Houston, TX 77030 USA
[2] Univ Texas Houston, Sch Med, Dept Neurol, Houston, TX 77030 USA
[3] Johns Hopkins Univ, Sch Med, Anesthesia Crit Care Med, Baltimore, MD USA
[4] Johns Hopkins Univ, Sch Med, Dept Neurol, Baltimore, MD 21205 USA
[5] Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA
关键词:
Subarachnoid hemorrhage;
Aneurysm;
Neurocritical care unit;
Case volume;
Caseload;
Outcome;
SPECIALIZED NEUROCRITICAL CARE;
HOSPITAL VOLUME;
MORTALITY;
STROKE;
NEUROINTENSIVIST;
ASSOCIATION;
MANAGEMENT;
D O I:
10.1016/j.jcrc.2015.01.007
中图分类号:
R4 [临床医学];
学科分类号:
1002 ;
100602 ;
摘要:
Purpose: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. Materials and Methods: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents. Results: A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 +/- 14.1 years, B: 53.1 +/- 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%). Conclusions: The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care. (C) 2015 Elsevier Inc. All rights reserved.
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页码:469 / 472
页数:4
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