Does the subspecialty of an intensive care unit (ICU) has an impact on outcome in patients suffering from aneurysmal subarachnoid hemorrhage?
We retrospectively compared the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients treated in a neurosurgical ICU (nICU) between 1990 and 2005 with that of patients treated in a general ICU (gICU) between 2005 and 2013 with almost identical treatment strategies. Among other parameters, we registered the initial Hunt and Hess grade, Fisher score, the incidence of vasospasm, and outcome. A multivariate analysis (logistic regression model) was performed to adjust for different variables. In total, 755 patients were included in this study with 456 patients assigned to the nICU and 299 patients to the gICU. Multivariate logistic regression analysis revealed no significant difference between the patient outcome treated in a nICU versus gICU after adjusting for different variables. The outcome of patients after aSAH is not influenced by the type of ICU (gICU versus nICU). The data do not allow claiming that aSAH patients need to be treated in a specialized ICU for obtaining better results. Parameters which might differ from hospital to hospital, especially warranty of neurosurgical expertise on gICU, have the potential to influence the results.
KeywordsSubarachnoid hemorrhage Outcome General intensive care unit Neurosurgical intensive care unit Subspecialty
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was reviewed by the local ethics committee (ethics committee Georg-August-University Göttingen), but did not need approval because it was a retrospective analysis of anonymous data.
Not needed because of anonymous patient data
- 2.Bederson JB, Sander Connolly E, Batjer H, Dacey RG, Dion JE, Diringer MN et al (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Assocation. Stroke 40:994–1025CrossRefPubMedGoogle Scholar
- 16.Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274CrossRefPubMedGoogle Scholar
- 17.Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group et al (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817CrossRefPubMedGoogle Scholar
- 18.Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS (2015) The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 385:691–697CrossRefPubMedCentralPubMedGoogle Scholar
- 21.Sarpong Y, Nattanmai P, Schelp G, Bell R, Premkumar K, Stapleton E, McCormick A, Newey CR (2017) Improvement in quality metrics outcomes and patient and family satisfaction in a neurosciences intensive care unit after creation of a dedicated neurocritical care team. Crit Care Res Pract 2017:6394105PubMedCentralPubMedGoogle Scholar