Abstract Body:
Introduction
Patients with aSAH that are critically ill often undergo interhospital transfer (IHT) for multiple reasons including emergent treatment, physician second opinion, and patient preference.^1,2 Clinical and radiographic predictors of early death and transition to comfort care may help guide IHT decisions.³ In this retrospective study, we seek to predictors for deterioration in aSAH patients undergoing IHT. We hypothesized that higher grade aSAH patients would be at a higher risk of early deterioration in the peri-interhospital transfer phase. Additionally, aSAH with early deterioration would be more likely to transition code status after IHT.
Methods
In this retrospective cohort study, we include a sample of 102 consecutive aSAH patients undergoing IHT from 2019 to 2023 within a large urban health system for multidisciplinary management. These patients were admitted to a neuroscience intensive care unit (NSICU) at the only comprehensive stroke center within our health system. Narratives on patient transfers are screened to categorize patients as “Early Deterioration SAH” based on the criteria defined as: pre-IHT deterioration in mental status requiring intubation, suspected raised intracranial pressure (ICP) requiring interventions and seizures.
Results
Of 102 patients with suspected aSAH undergoing IHT, 56% experienced pre-IHT early deterioration (n = 58). We found that women with suspected aSAH were more than three times likely to experience early deterioration when compared to men (OR 3.15, [95% CI, 1.38-7.20], p < 0.05). Hispanic patients, when compared to whites, with suspected aSAH were more likely to experience early deterioration (OR 1.28, [95% CI, 0.39-4.24], p < 0.05). Patients with increased SAH severity (HH >2) were more than 25 times more likely to experience early deterioration compared to those that did not deteriorate (OR 25.37, [95% CI, 8.82-73), p < 0.001). Transition of code status to DNR/DNI in patients with aSAH that experienced early deterioration was not disproportionately different compared to those that did not deteriorate (14% vs 7%, respectively, Z-score = 2.52, p-value = 1.98).
Conclusion
In conclusion, for aSAH patients undergoing IHT, severity of aSAH, female sex, and Hispanic ethnicity were associated with a higher risk of early clinical deterioration. Patients experiencing deterioration do not disproportionately convert to DNR/DNI, when compared to patients that did not deteriorate.