Low Jacob C M, Welbourne Jessie, McMillan Helen, Whitfield Peter C
a South West Neurosurgical Centre , Derriford Hospital , Plymouth , UK ;
b Department of Critical Care , Derriford Hospital , Plymouth , UK.
Br J Neurosurg. 2016 Oct;30(5):545-8. doi: 10.1080/02688697.2016.1199782. Epub 2016 Jun 22.
Subarachnoid haemorrhage (SAH) patients will typically require monitoring in a specialised Neurocritical Care Unit (NCCU) regardless of the primary treatment modality. Once discharged from NCCU, readmission within 48 h is regarded as a "failed" discharge. The aims of this study are to (1) Evaluate the readmission rate of SAH patients into NCCU, (2) Identify the indications for readmission, (3) Analyse clinical parameters on discharge between patients readmitted early and late.
Retrospective observational study of the Intensive Care National Audit and Research Centre (ICNARC) database of patients from our unit diagnosed with SAH from January 2009-December 2014, who were readmitted into NCCU. Demographic data, World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, length of initial and subsequent NCCU stay, time of readmission, indication for readmission, and mortality rate data were collected. Patients were categorised by early (<48 h) and late (>48 h) readmission, and their clinical parameters on NCCU discharge were statistically analysed.
Five hundred and seventy-five SAH patients were admitted into NCCU, of which 49 patients (9%) were readmitted after discharge to ward-level care. The mean age of readmitted patients was 64.1 ± 11.6 years old. The most common indications were delayed cerebral ischaemia (DCI) (50%) and infection (19%). Readmitted SAH patients were typically WFNS grade I-II (n = 22) and Fisher grade III-IV (n = 44). 17 (35%) patients were readmitted early, and were older (p = 0.0049) with a lower GCS (p = 0.0077) compared to patients readmitted later. White cell count and C-reactive protein were higher in patients readmitted early, but did not reach statistical significance (p = 0.09, p = 0.07).
DCI and infection were the most common indications for NCCU readmission in SAH patients. "Failed" discharged patients from NCCU are typically older with a lower GCS than patients readmitted after 48 h, and therefore clinicians should be more cautious in discharging these patients prematurely.
无论采用何种主要治疗方式，蛛网膜下腔出血（SAH）患者通常都需要在专门的神经重症监护病房（NCCU）进行监测。一旦从NCCU出院，48小时内再次入院被视为“出院失败”。本研究的目的是：（1）评估SAH患者再次入住NCCU的比例；（2）确定再次入院的指征；（3）分析早期和晚期再次入院患者出院时的临床参数。
对2009年1月至2014年12月在我院诊断为SAH且再次入住NCCU的患者的重症监护国家审计与研究中心（ICNARC）数据库进行回顾性观察研究。收集人口统计学数据、世界神经外科协会联盟（WFNS）分级、Fisher分级、首次及后续在NCCU的住院时间、再次入院时间、再次入院指征及死亡率数据。患者按早期（<48小时）和晚期（>48小时）再次入院进行分类，并对其在NCCU出院时的临床参数进行统计学分析。
575例SAH患者入住NCCU，其中49例（9%）在出院至病房护理后再次入院。再次入院患者的平均年龄为64.1±11.6岁。最常见的指征是迟发性脑缺血（DCI）（50%）和感染（19%）。再次入院的SAH患者通常为WFNS I-II级（n = 22）和Fisher III-IV级（n = 44）。17例（35%）患者早期再次入院，与晚期再次入院患者相比，年龄更大（p = 0.0049），格拉斯哥昏迷量表（GCS）评分更低（p = 0.0077）。早期再次入院患者的白细胞计数和C反应蛋白更高，但未达到统计学意义（p = 0.09，p = 0.07）。
DCI和感染是SAH患者再次入住NCCU最常见的指征。NCCU“出院失败”的患者通常比48小时后再次入院的患者年龄更大，GCS评分更低，因此临床医生在过早出院这些患者时应更加谨慎。
