Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage

Jonathan Weyhenmeyer, Cristian F. Guandique, Adam Leibold, Stephen Lehnert, Jonathan Parish, Woody Han, Chad Tuchek, Janit Pandya, Thomas Leipzig, Troy Payner, Andrew DeNardo, John Scott, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Most patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) initially present to a hospital that lacks a neurosurgical unit. These patients require interhospital transfer (IHT) to tertiary facilities capable of multidisciplinary neurosurgical intervention. Yet, little is known about the effects of IHT on the outcomes of patients suffering from aSAH. In this study, the authors examined the effects of IHT and transport method on the timing of treatment, rebleed rates, and overall outcomes of patients who have experienced aSAH. METHODS: A retrospective review of medical records identified all consecutive patients who presented with aSAH at an outside hospital and subsequently underwent IHT to a tertiary aneurysm care center and patients who initially presented directly to a tertiary aneurysm care facility between 2008 and 2015. Demographic, operative, radiological, hospital of initial evaluation, transfer method, and outcome data were retrospectively collected. RESULTS: The authors identified 763 consecutive patients who were evaluated for aSAH at a tertiary aneurysm care facility either directly or following IHT. For patients who underwent IHT and after accounting for these patients' clinical variability and dichotomizing the patients into groups transferred less than 20 miles and more than 20 miles, the authors noted a significant increase in mortality rates: 7% (< 20 miles) and 18.8% (> 20 miles) (p = 0.004). The increased mortality rate was partially explained by an increased rate of initial presentation to an accredited stroke center in patients undergoing IHT of less than 20 miles (p = 0.000). The method of transport (ground or air ambulance) was found to have significant effect on the patients' outcomes as measured by the Glasgow Outcome Scale score (p = 0.021); patients who underwent ground transport demonstrated a higher likelihood of discharge to home (p = 0.004). The increased severity of presentation in the patient cohort undergoing IHT by air as defined by the Glasgow Coma Scale score, a need for an external ventricular drain, Hunt and Hess grade, and intubation status at presentation did not result in increased mortality when compared with the ground cohort (p = 0.074). In addition, there was an 8-hour increase in duration of time from admission to treatment for the air cohort as compared with the ground cohort (p = 0.054), indicating a potential for further improvement in the overall outcome of this patient group. CONCLUSIONS: Aneurysmal SAH remains a challenging neurosurgical disease process requiring highly coordinated care in tertiary referral centers. In this study, the overall distance traveled and the transport method affected patient outcomes. The time from admission to treatment should continue to improve. Further analysis of IHT with a focus on patient monitoring and treatment during transport is warranted.

Original languageEnglish (US)
Pages (from-to)490-498
Number of pages9
JournalJournal of Neurosurgery
Volume128
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Subarachnoid Hemorrhage
Mortality
Aneurysm
Tertiary Healthcare
Tertiary Care Centers
Air Ambulances
Air
Glasgow Outcome Scale
Glasgow Coma Scale
Physiologic Monitoring
Therapeutics
Intubation
Medical Records

Keywords

  • Aneurysmal subarachnoid hemorrhage
  • Interhospital transfer
  • Outcomes
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage. / Weyhenmeyer, Jonathan; Guandique, Cristian F.; Leibold, Adam; Lehnert, Stephen; Parish, Jonathan; Han, Woody; Tuchek, Chad; Pandya, Janit; Leipzig, Thomas; Payner, Troy; DeNardo, Andrew; Scott, John; Cohen-Gadol, Aaron.

In: Journal of Neurosurgery, Vol. 128, No. 2, 01.02.2018, p. 490-498.

Research output: Contribution to journalArticle

Weyhenmeyer, J, Guandique, CF, Leibold, A, Lehnert, S, Parish, J, Han, W, Tuchek, C, Pandya, J, Leipzig, T, Payner, T, DeNardo, A, Scott, J & Cohen-Gadol, A 2018, 'Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage', Journal of Neurosurgery, vol. 128, no. 2, pp. 490-498. https://doi.org/10.3171/2016.9.JNS16668
Weyhenmeyer, Jonathan ; Guandique, Cristian F. ; Leibold, Adam ; Lehnert, Stephen ; Parish, Jonathan ; Han, Woody ; Tuchek, Chad ; Pandya, Janit ; Leipzig, Thomas ; Payner, Troy ; DeNardo, Andrew ; Scott, John ; Cohen-Gadol, Aaron. / Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage. In: Journal of Neurosurgery. 2018 ; Vol. 128, No. 2. pp. 490-498.
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AU - Parish, Jonathan

AU - Han, Woody

AU - Tuchek, Chad

AU - Pandya, Janit

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N2 - OBJECTIVE: Most patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) initially present to a hospital that lacks a neurosurgical unit. These patients require interhospital transfer (IHT) to tertiary facilities capable of multidisciplinary neurosurgical intervention. Yet, little is known about the effects of IHT on the outcomes of patients suffering from aSAH. In this study, the authors examined the effects of IHT and transport method on the timing of treatment, rebleed rates, and overall outcomes of patients who have experienced aSAH. METHODS: A retrospective review of medical records identified all consecutive patients who presented with aSAH at an outside hospital and subsequently underwent IHT to a tertiary aneurysm care center and patients who initially presented directly to a tertiary aneurysm care facility between 2008 and 2015. Demographic, operative, radiological, hospital of initial evaluation, transfer method, and outcome data were retrospectively collected. RESULTS: The authors identified 763 consecutive patients who were evaluated for aSAH at a tertiary aneurysm care facility either directly or following IHT. For patients who underwent IHT and after accounting for these patients' clinical variability and dichotomizing the patients into groups transferred less than 20 miles and more than 20 miles, the authors noted a significant increase in mortality rates: 7% (< 20 miles) and 18.8% (> 20 miles) (p = 0.004). The increased mortality rate was partially explained by an increased rate of initial presentation to an accredited stroke center in patients undergoing IHT of less than 20 miles (p = 0.000). The method of transport (ground or air ambulance) was found to have significant effect on the patients' outcomes as measured by the Glasgow Outcome Scale score (p = 0.021); patients who underwent ground transport demonstrated a higher likelihood of discharge to home (p = 0.004). The increased severity of presentation in the patient cohort undergoing IHT by air as defined by the Glasgow Coma Scale score, a need for an external ventricular drain, Hunt and Hess grade, and intubation status at presentation did not result in increased mortality when compared with the ground cohort (p = 0.074). In addition, there was an 8-hour increase in duration of time from admission to treatment for the air cohort as compared with the ground cohort (p = 0.054), indicating a potential for further improvement in the overall outcome of this patient group. CONCLUSIONS: Aneurysmal SAH remains a challenging neurosurgical disease process requiring highly coordinated care in tertiary referral centers. In this study, the overall distance traveled and the transport method affected patient outcomes. The time from admission to treatment should continue to improve. Further analysis of IHT with a focus on patient monitoring and treatment during transport is warranted.

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