PMID- 28327914
OWN - NLM
STAT- MEDLINE
DCOM- 20180323
LR  - 20181202
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 81
IP  - 2
DP  - 2017 Aug 1
TI  - Neurosurgical Emergency Transfers: An Analysis of Deterioration and Mortality.
PG  - 240-250
LID - 10.1093/neuros/nyx012 [doi]
AB  - BACKGROUND: Neurological deterioration and mortality are frequent in
      neurosurgical patients transferred to tertiary centers, but the precise
      predictors leading to them are unclear. OBJECTIVE: To analyze and quantify risk
      factors predicting deterioration and death in neurosurgery transfers. METHODS: A 
      consecutive review of all transfers with cranial pathology to a tertiary academic
      neurosurgery service was performed over a 2-year period. Risk factors including
      demographics, medical comorbidities, hydrocephalus, anticoagulant use, transfer
      diagnosis, Glasgow Coma Scale score, and transfer time were reviewed. RESULTS: A 
      total of 1429 transfers were studied, including 154 (10.8%) instances of
      neurological decline in transit and 99 mortalities (6.9%). On multivariate
      analysis, significant predictors of decline were hydrocephalus ( P = .005, odds
      ratio [OR] 2) and use of clopidogrel ( P = .003, OR 4.3), warfarin ( P = .004, OR
      2.6), or other systemic anticoagulants ( P < .001, OR 10.1). Age ( P = .004),
      hydrocephalus ( P = .006, OR 2.1), renal failure ( P = .05, OR 2.3), and use of
      clopidogrel ( P = .003, OR 4.6) or warfarin ( P = .03, OR 2.3) were found to be
      predictive of death. Analysis by transfer diagnosis found patients with
      intracerebral hemorrhage had the highest incidence of mortality (12.7%, P = .003,
      OR 2). Patients who ultimately died were transferred faster than survivors, but
      this did not achieve significance. CONCLUSION: Neurosurgery patients are
      vulnerable to deterioration in transit and exhibit several patterns predictive of
      mortality. Hydrocephalus, use of clopidogrel and warfarin, and intracerebral
      hemorrhage are each independently associated with elevated risk of deterioration 
      and death.
CI  - Copyright (c) 2017 by the Congress of Neurological Surgeons
FAU - Alaraj, Ali
AU  - Alaraj A
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Esfahani, Darian R
AU  - Esfahani DR
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Hussein, Ahmed E
AU  - Hussein AE
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Darie, Ioana
AU  - Darie I
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Amin-Hanjani, Sepideh
AU  - Amin-Hanjani S
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Slavin, Konstantin V
AU  - Slavin KV
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Du, Xinjian
AU  - Du X
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
FAU - Charbel, Fady T
AU  - Charbel FT
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
RN  - 0 (Anticoagulants)
SB  - IM
EIN - Neurosurgery. 2017 Oct 1;81(4):709. PMID: 28934450
MH  - Anticoagulants
MH  - Cerebral Hemorrhage
MH  - Emergency Medical Services/*statistics & numerical data
MH  - Humans
MH  - Hydrocephalus
MH  - *Neurosurgical Procedures/mortality/statistics & numerical data
MH  - Patient Transfer/*statistics & numerical data
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - Clopidogrel
OT  - Deterioration
OT  - Intracerebral hemorrhage
OT  - Mortality
OT  - Subarachnoid hemorrhage
OT  - Transfer
OT  - Warfarin
EDAT- 2017/03/23 06:00
MHDA- 2018/03/24 06:00
CRDT- 2017/03/23 06:00
PHST- 2016/03/25 00:00 [received]
PHST- 2017/01/13 00:00 [accepted]
PHST- 2017/03/23 06:00 [pubmed]
PHST- 2018/03/24 06:00 [medline]
PHST- 2017/03/23 06:00 [entrez]
AID - 3065537 [pii]
AID - 10.1093/neuros/nyx012 [doi]
PST - ppublish
SO  - Neurosurgery. 2017 Aug 1;81(2):240-250. doi: 10.1093/neuros/nyx012.