Predicting the lack of development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Emanuela Crobeddu, Manoj K. Mittal, Stefan Dupont, Eelco F M Wijdicks, Giuseppe Lanzino, Alejandro Rabinstein

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: Patients with aneurysmal subarachnoid hemorrhage are typically kept in the intensive care unit to be monitored for signs of delayed cerebral ischemia (DCI). Identifying patients at lower risk for DCI could have a positive financial impact by allowing earlier transfer from the intensive care unit. METHODS-: We analyzed 307 consecutive patients admitted to the intensive care unit. Demographic, clinical, and neuroimaging data were recorded. The relationship with absent DCI was analyzed using univariate and multivariate logistic regression models. RESULTS-: DCI did not develop in 169 patients (57.9%). Among factors at admission, age 68 years or older (P=0.0003; OR, 3.16; 95% CI, 1.66-6.39), World Federation of Neurological Surgeons (WFNS) I to III at presentation (P=0.0003; OR, 2.73; 95% CI, 1.57-4.79), WFNS I to III at worst (P=0.0003; OR, 2.39; 95% CI, 1.48-3.87), WFNS I to III after resuscitation (P=0.0006; OR, 2.85; 95% CI, 1.56-5.32), modified Fisher grade 1 to 2 (P=0.0021; OR, 2.43; 95% CI, 1.37-4.47), absence of intracranial hematoma (P=0.0042; OR, 2.26; 95% CI, 1.29-4.01), and aneurysm in the posterior circulation (P=0.025; OR, 1.74; 95% CI, 1.07-2.87) were associated with absence of DCI. On multivariate analysis, a model including age 68 years or older, WFNS I to III at presentation and a modified Fisher grade 1 to 2 were independently predictive of the absence of DCI, with a specificity of 100% and a positive predictive value of 100%. CONCLUSIONS-: We propose a new model that can reliably identify patients with aneurysmal subarachnoid hemorrhage who are at very low risk for DCI. These patients could be candidates for early transfer to the general ward.

Original languageEnglish (US)
Pages (from-to)697-701
Number of pages5
JournalStroke
Volume43
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Subarachnoid Hemorrhage
Brain Ischemia
Intensive Care Units
Logistic Models
Patients' Rooms
Neuroimaging
Resuscitation
Hematoma
Aneurysm
Multivariate Analysis
Demography
Neurosurgeons

Keywords

  • absent
  • aneurysmal subarachnoid hemorrhage
  • cerebral ischemia
  • delayed
  • predictive values

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Predicting the lack of development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. / Crobeddu, Emanuela; Mittal, Manoj K.; Dupont, Stefan; Wijdicks, Eelco F M; Lanzino, Giuseppe; Rabinstein, Alejandro.

In: Stroke, Vol. 43, No. 3, 03.2012, p. 697-701.

Research output: Contribution to journalArticle

Crobeddu, Emanuela ; Mittal, Manoj K. ; Dupont, Stefan ; Wijdicks, Eelco F M ; Lanzino, Giuseppe ; Rabinstein, Alejandro. / Predicting the lack of development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. In: Stroke. 2012 ; Vol. 43, No. 3. pp. 697-701.
@article{da0bc87e09c848a6bef6bd6ca2fe1875,
title = "Predicting the lack of development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage",
abstract = "BACKGROUND AND PURPOSE-: Patients with aneurysmal subarachnoid hemorrhage are typically kept in the intensive care unit to be monitored for signs of delayed cerebral ischemia (DCI). Identifying patients at lower risk for DCI could have a positive financial impact by allowing earlier transfer from the intensive care unit. METHODS-: We analyzed 307 consecutive patients admitted to the intensive care unit. Demographic, clinical, and neuroimaging data were recorded. The relationship with absent DCI was analyzed using univariate and multivariate logistic regression models. RESULTS-: DCI did not develop in 169 patients (57.9{\%}). Among factors at admission, age 68 years or older (P=0.0003; OR, 3.16; 95{\%} CI, 1.66-6.39), World Federation of Neurological Surgeons (WFNS) I to III at presentation (P=0.0003; OR, 2.73; 95{\%} CI, 1.57-4.79), WFNS I to III at worst (P=0.0003; OR, 2.39; 95{\%} CI, 1.48-3.87), WFNS I to III after resuscitation (P=0.0006; OR, 2.85; 95{\%} CI, 1.56-5.32), modified Fisher grade 1 to 2 (P=0.0021; OR, 2.43; 95{\%} CI, 1.37-4.47), absence of intracranial hematoma (P=0.0042; OR, 2.26; 95{\%} CI, 1.29-4.01), and aneurysm in the posterior circulation (P=0.025; OR, 1.74; 95{\%} CI, 1.07-2.87) were associated with absence of DCI. On multivariate analysis, a model including age 68 years or older, WFNS I to III at presentation and a modified Fisher grade 1 to 2 were independently predictive of the absence of DCI, with a specificity of 100{\%} and a positive predictive value of 100{\%}. CONCLUSIONS-: We propose a new model that can reliably identify patients with aneurysmal subarachnoid hemorrhage who are at very low risk for DCI. These patients could be candidates for early transfer to the general ward.",
keywords = "absent, aneurysmal subarachnoid hemorrhage, cerebral ischemia, delayed, predictive values",
author = "Emanuela Crobeddu and Mittal, {Manoj K.} and Stefan Dupont and Wijdicks, {Eelco F M} and Giuseppe Lanzino and Alejandro Rabinstein",
year = "2012",
month = "3",
doi = "10.1161/STROKEAHA.111.638403",
language = "English (US)",
volume = "43",
pages = "697--701",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Predicting the lack of development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

AU - Crobeddu, Emanuela

AU - Mittal, Manoj K.

AU - Dupont, Stefan

AU - Wijdicks, Eelco F M

AU - Lanzino, Giuseppe

AU - Rabinstein, Alejandro

PY - 2012/3

Y1 - 2012/3

N2 - BACKGROUND AND PURPOSE-: Patients with aneurysmal subarachnoid hemorrhage are typically kept in the intensive care unit to be monitored for signs of delayed cerebral ischemia (DCI). Identifying patients at lower risk for DCI could have a positive financial impact by allowing earlier transfer from the intensive care unit. METHODS-: We analyzed 307 consecutive patients admitted to the intensive care unit. Demographic, clinical, and neuroimaging data were recorded. The relationship with absent DCI was analyzed using univariate and multivariate logistic regression models. RESULTS-: DCI did not develop in 169 patients (57.9%). Among factors at admission, age 68 years or older (P=0.0003; OR, 3.16; 95% CI, 1.66-6.39), World Federation of Neurological Surgeons (WFNS) I to III at presentation (P=0.0003; OR, 2.73; 95% CI, 1.57-4.79), WFNS I to III at worst (P=0.0003; OR, 2.39; 95% CI, 1.48-3.87), WFNS I to III after resuscitation (P=0.0006; OR, 2.85; 95% CI, 1.56-5.32), modified Fisher grade 1 to 2 (P=0.0021; OR, 2.43; 95% CI, 1.37-4.47), absence of intracranial hematoma (P=0.0042; OR, 2.26; 95% CI, 1.29-4.01), and aneurysm in the posterior circulation (P=0.025; OR, 1.74; 95% CI, 1.07-2.87) were associated with absence of DCI. On multivariate analysis, a model including age 68 years or older, WFNS I to III at presentation and a modified Fisher grade 1 to 2 were independently predictive of the absence of DCI, with a specificity of 100% and a positive predictive value of 100%. CONCLUSIONS-: We propose a new model that can reliably identify patients with aneurysmal subarachnoid hemorrhage who are at very low risk for DCI. These patients could be candidates for early transfer to the general ward.

AB - BACKGROUND AND PURPOSE-: Patients with aneurysmal subarachnoid hemorrhage are typically kept in the intensive care unit to be monitored for signs of delayed cerebral ischemia (DCI). Identifying patients at lower risk for DCI could have a positive financial impact by allowing earlier transfer from the intensive care unit. METHODS-: We analyzed 307 consecutive patients admitted to the intensive care unit. Demographic, clinical, and neuroimaging data were recorded. The relationship with absent DCI was analyzed using univariate and multivariate logistic regression models. RESULTS-: DCI did not develop in 169 patients (57.9%). Among factors at admission, age 68 years or older (P=0.0003; OR, 3.16; 95% CI, 1.66-6.39), World Federation of Neurological Surgeons (WFNS) I to III at presentation (P=0.0003; OR, 2.73; 95% CI, 1.57-4.79), WFNS I to III at worst (P=0.0003; OR, 2.39; 95% CI, 1.48-3.87), WFNS I to III after resuscitation (P=0.0006; OR, 2.85; 95% CI, 1.56-5.32), modified Fisher grade 1 to 2 (P=0.0021; OR, 2.43; 95% CI, 1.37-4.47), absence of intracranial hematoma (P=0.0042; OR, 2.26; 95% CI, 1.29-4.01), and aneurysm in the posterior circulation (P=0.025; OR, 1.74; 95% CI, 1.07-2.87) were associated with absence of DCI. On multivariate analysis, a model including age 68 years or older, WFNS I to III at presentation and a modified Fisher grade 1 to 2 were independently predictive of the absence of DCI, with a specificity of 100% and a positive predictive value of 100%. CONCLUSIONS-: We propose a new model that can reliably identify patients with aneurysmal subarachnoid hemorrhage who are at very low risk for DCI. These patients could be candidates for early transfer to the general ward.

KW - absent

KW - aneurysmal subarachnoid hemorrhage

KW - cerebral ischemia

KW - delayed

KW - predictive values

UR - http://www.scopus.com/inward/record.url?scp=84857644459&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857644459&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.111.638403

DO - 10.1161/STROKEAHA.111.638403

M3 - Article

C2 - 22198987

AN - SCOPUS:84857644459

VL - 43

SP - 697

EP - 701

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 3

ER -