Neuroscience Intensive Care Unit, Department of Neurosurgery, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1136, New York, NY USA.
Neurocrit Care. 2011 Apr;14(2):260-6. doi: 10.1007/s12028-010-9418-2.
Little current data exists regarding outcome, cost, and length of stay (LOS) after subdural hemorrhage (SDH). We sought to examine predictors of discharge disposition, ICU and hospital LOS and direct, indirect, ICU, surgical, and diagnostic costs for SDH.
A retrospective review was conducted of 216 SDH patients, aged >18 years admitted to our hospital between 1/2001 and 12/2008. Discharge disposition was characterized as dead, poor or good. Multivariable logistic regression analysis was performed to identify predictors of disposition, LOS, and cost.
Of 216 SDH patients, the median age was 74 (19-95), and the median admission Glasgow Coma Scale (GCS) was 14 (3-15). The SDH was characterized as acute in 14%, subacute in 44%, chronic in 12%, and mixed in 30%. Surgical evacuation was performed in 139 (64%) patients. Death occurred in 29 (13%) patients and poor disposition in 43 (20%). Significant predictors of death included age, admission GCS, and hospital LOS (P < 0.05). Longer hospital LOS was associated with poor disposition, while shorter ICU LOS was associated with good disposition (P < 0.01). Median hospital LOS was 8 (1-99) days. Median total direct costs for hospitalization were $10,670 ($907-238,856). ICU and hospital LOS were significant predictors of all measures of cost (P < 0.05). SDH size, chronicity, and surgical intervention were not predictors of any outcome. There was no significant change in any outcome variable between 2001 and 2008.
Despite good admission neurological status, death or poor discharge disposition is common after SDH. LOS and costs remain high and have not improved in the last decade.
目前关于硬膜下血肿（SDH）后结局、成本和住院时间（LOS）的数据很少。我们旨在研究 SDH 患者出院去向、ICU 和住院 LOS 以及直接、间接、ICU、手术和诊断成本的预测因素。
对 2001 年 1 月至 2008 年 12 月期间我院收治的 216 例年龄>18 岁的 SDH 患者进行回顾性分析。出院去向的特征为死亡、预后不良或预后良好。采用多变量逻辑回归分析来确定去向、LOS 和成本的预测因素。
216 例 SDH 患者的中位年龄为 74 岁（19-95 岁），入院格拉斯哥昏迷量表（GCS）评分的中位数为 14 分（3-15 分）。SDH 为急性 14%、亚急性 44%、慢性 12%和混合性 30%。139 例（64%）患者行手术清除血肿。29 例（13%）患者死亡，43 例（20%）患者预后不良。死亡的显著预测因素包括年龄、入院 GCS 和住院 LOS（P<0.05）。较长的住院 LOS 与预后不良相关，而较短的 ICU LOS 与预后良好相关（P<0.01）。中位住院 LOS 为 8 天（1-99 天）。总住院费用中位数为 10670 美元（907-238856 美元）。ICU 和住院 LOS 是所有成本指标的显著预测因素（P<0.05）。SDH 大小、慢性和手术干预不是任何结局的预测因素。2001 年至 2008 年期间，任何结局变量均无显著变化。
尽管入院时神经功能良好，但 SDH 后仍常出现死亡或预后不良。LOS 和成本仍然很高，在过去十年中并未改善。
