Impact of specialist neurovascular care in XXXX .

@entity1 @entity1779 @entity74 @entity510
BACKGROUND: The management of @entity74 has become increasingly specialised. The care of @entity1 with @entity510 ( @entity510 ) has generally been part of core neurosurgical practice, provided by general neurosurgeons whatever their specialist interest. The aim of this present study therefore is to ascertain if, and to what extent care provided by a dedicated neurovascular team (compared to care provided by a general neurosurgical team) change @entity1 disposition in @entity510 . METHODS: This is a retrospective analysis of @entity510 @entity1 , identified from a departmental database of a single neurosurgical centre. In 2008, the service was reorganised such that a neurovascular team cared for all @entity510 @entity1 . We compared clinical outcome in @entity1 admitted prior to this service reorganisation (Period A, 2004-2007) with @entity1 admitted afterwards (Period B, 2009-2011). Survival and recovery were assessed according to the Glasgow Outcome Scale (GOS). Multi-factorial logistic regression analysis was performed to determine the injury and age adjusted incidence of complications, odds of survival at discharge, discharge home, mortality, good recovery (GOS 5) and favourable outcome, by dichotomising GOS (GOS 4-5 vs. GOS 1-3) at 3 months. RESULTS: 1114 @entity1 were included in the study. The mean age of @entity1 presenting in Period A (n=543) was younger [50 years (SD 13.5)] than those in Period B (n=571) [53 years (SD 13)]. @entity1 admitted in Period B were more likely to present as poor grade (World Federation of Neurological surgeons (WFNS) grades 4 and 5) compared to Period A (26.5% vs. 21.3%). No statistical differences between the groups in the incidence of pre-operative re-bleeding (3% vs. 5%) or rates of delayed @entity1779 (16.1% vs. 16.1%) were observed. After adjustment for age, sex and injury severity, the odds of @entity1 time to discharge, discharge home and good recovery (GOS 5) were 27% (p<0.001), 45% (p=0.001) and 93% (p<0.001) higher respectively in Period B than Period A. CONCLUSIONS: The data presented here demonstrates that management of @entity510 by a dedicated neurovascular team improves the potential for @entity1 recovery.
