Type of admission is associated with outcome of spontaneous subarachnoid hemorrhage.
BACKGROUND
Admitting facility may significantly affect outcome for spontaneous subarachnoid hemorrhage patients. We assessed outcomes of patients admitted directly to a comprehensive stroke center with those initially admitted to a general hospital and subsequently transferred. The comprehensive stroke center included a neurocritical care ICU, cerebrovascular neurosurgeons and endovascular specialists.


METHODS
We identified 107 consecutive spontaneous subarachnoid hemorrhage cases. Of these cases, 31 (29%) patients were admitted directly and 76 (71%) were transferred from general hospitals. Univariate and multivariate analyses evaluated differences in mortality, complications, discharge disposition, and in-hospital length of stay.


RESULTS
Differences in baseline parameters (age, gender, admission Glasgow Coma Scale, Fisher grade, admission Hunt and Hess grade) were not statistically significant between direct-admit and transfer patients at our institution. Transferred patients developed vasospasm more frequently (58% vs. 32%; P < 0.05) and had a longer delay time to surgery (3.9-days vs. 2.4-days: P < 0.05). Multivariate analysis showed that the likelihood of vasospasm was significantly higher for transfer patients (OR 3.46, CI: 1.2-10.3, P = 0.03). In addition, longer in-hospital stays and higher odds of non-routine discharge were observed in transferred patients (P < 0.01). No differences in outcome could be identified for surgical vs. endovascular treatment rates between direct-admit and transfer patients. An association, but no causative link, can be made between the effect of transfer and the outcomes of SAH patients due to the retrospective nature of our study.


CONCLUSIONS
Spontaneous subarachnoid hemorrhage patients admitted directly to our comprehensive stroke center showed less complications compared to those transferred from general hospitals. This improvement was independent of time to treatment. Additional research in multiple centers using prospective analysis should be conducted to confirm that preferential direct transport to a comprehensive stroke center would likely yield considerable improvements in public health.
['Drazin|Doniel|D|', 'Rosner|Jack|J|', 'Nuño|Miriam|M|', 'Alexander|Michael J|MJ|', 'Schievink|Wouter I|WI|', 'Palestrant|David|D|', 'Lyden|Patrick D|PD|', 'Miller|Chad|C|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D010343:Patient Admission D010351:Patient Discharge D010360:Patient Transfer D012189:Retrospective Studies D013345:Subarachnoid Hemorrhage D020301:Vasospasm, Intracranial D055815:Young Adult
subarachnoid hemorrhage admitting facility comprehensive stroke center vasospasm neurovascular center tertiary care center