Association between weekend admissions and mortality after aneurysmal subarachnoid hemorrhage: the “weekend effect” revisited

OBJECTIVEHigher mortality has been reported with weekend or after-hours patient admission across a wide range of surgical and medical specialties, a phenomenon termed the “weekend effect.” The authors evaluated whether weekend admission contributed to death and long-term neurological outcome in patients following aneurysmal subarachnoid hemorrhage.METHODSA post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) study was conducted. Univariable and stepwise multivariable logistic regression analyses were performed to assess the associations between weekend admission and mortality and long-term neurological outcome.RESULTSOf 413 subjects included in the CONSCIOUS-1 study, 140 patients had been admitted during the weekend. A significant interaction was identified between weekend admission and neurological grade on presentation, suggesting that the outcomes of patients who had initially presented with a poor grade were disproportionately influenced by the weekend admission. On stepwise multivariable logistic regression in the subgroup of patients who had presented with a poor neurological grade (29 of 100 patients), admission on the weekend was found to be independently associated with death (OR 6.59, 95% CI 1.62–26.88, p = 0.009). Weekend admission was not associated with long-term neurological outcome.CONCLUSIONSWeekend admission was an independent risk factor for death within 12 weeks following aneurysmal subarachnoid hemorrhage in patients presenting with a poor neurological grade. Further work is required to identify and mitigate any mediating factors.

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Letter: Predicting Long-Term Outcomes After Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Decision Tree Modeling

Neurosurgery ◽

10.1093/neuros/nyaa511 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jaskaran Singh Gosal ◽

Kuntal Kanti Das ◽

Deepak Khatri ◽

Kamlesh Singh Bhaisora ◽

Sanjay Behari

Keyword(s):

Subarachnoid Hemorrhage ◽

Decision Tree ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Long Term Outcomes ◽

Poor Grade ◽

Tree Modeling

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In Reply: Predicting Long-Term Outcomes After Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Decision Tree Modeling

Neurosurgery ◽

10.1093/neuros/nyaa521 ◽

2020 ◽

Author(s):

Bing Zhao ◽

Jinjin Liu

Keyword(s):

Subarachnoid Hemorrhage ◽

Decision Tree ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Long Term Outcomes ◽

Poor Grade ◽

Tree Modeling

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Pupillary Reactivity Upon Hospital Admission Predicts Long-term Outcome in Poor Grade Aneurysmal Subarachnoid Hemorrhage Patients

Neurocritical Care ◽

10.1007/s12028-007-9031-1 ◽

2007 ◽

Vol 8 (3) ◽

pp. 374-379 ◽

Cited By ~ 15

Author(s):

William J. Mack ◽

Zachary L. Hickman ◽

Andrew F. Ducruet ◽

James T. Kalyvas ◽

Matthew C. Garrett ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Admission ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Term Outcome ◽

Long Term Outcome ◽

Poor Grade ◽

Pupillary Reactivity

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An Externally Validated Dynamic Nomogram for Predicting Unfavorable Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Frontiers in Neurology ◽

10.3389/fneur.2021.683051 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ping Hu ◽

Yang Xu ◽

Yangfan Liu ◽

Yuntao Li ◽

Liguo Ye ◽

...

Keyword(s):

Logistic Regression ◽

Prognostic Factors ◽

Subarachnoid Hemorrhage ◽

Validation Cohort ◽

Aneurysmal Subarachnoid Hemorrhage ◽

External Validation ◽

Brier Score ◽

Web Based ◽

Training Cohort ◽

Multivariable Logistic Regression

Background: Aneurysmal subarachnoid hemorrhage (aSAH) leads to severe disability and functional dependence. However, no reliable method exists to predict the clinical prognosis after aSAH. Thus, this study aimed to develop a web-based dynamic nomogram to precisely evaluate the risk of poor outcomes in patients with aSAH.Methods: Clinical patient data were retrospectively analyzed at two medical centers. One center with 126 patients was used to develop the model. Least absolute shrinkage and selection operator (LASSO) analysis was used to select the optimal variables. Multivariable logistic regression was applied to identify independent prognostic factors and construct a nomogram based on the selected variables. The C-index and Hosmer–Lemeshow p-value and Brier score was used to reflect the discrimination and calibration capacities of the model. Receiver operating characteristic curve and calibration curve (1,000 bootstrap resamples) were generated for internal validation, while another center with 84 patients was used to validate the model externally. Decision curve analysis (DCA) and clinical impact curves (CICs) were used to evaluate the clinical usefulness of the nomogram.Results: Unfavorable prognosis was observed in 46 (37%) patients in the training cohort and 24 (29%) patients in the external validation cohort. The independent prognostic factors of the nomogram, including neutrophil-to-lymphocyte ratio (NLR) (p = 0.005), World Federation of Neurosurgical Societies (WFNS) grade (p = 0.002), and delayed cerebral ischemia (DCI) (p = 0.0003), were identified using LASSO and multivariable logistic regression. A dynamic nomogram (https://hu-ping.shinyapps.io/DynNomapp/) was developed. The nomogram model demonstrated excellent discrimination, with a bias-corrected C-index of 0.85, and calibration capacities (Hosmer–Lemeshow p-value, 0.412; Brier score, 0.12) in the training cohort. Application of the model to the external validation cohort yielded a C-index of 0.84 and a Brier score of 0.13. Both DCA and CIC showed a superior overall net benefit over the entire range of threshold probabilities.Conclusion: This study identified that NLR on admission, WFNS grade, and DCI independently predicted unfavorable prognosis in patients with aSAH. These factors were used to develop a web-based dynamic nomogram application to calculate the precise probability of a poor patient outcome. This tool will benefit personalized treatment and patient management and help neurosurgeons make better clinical decisions.

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Decompressive Hemicraniectomy for Poor-grade Aneurysmal Subarachnoid Hemorrhage Patients with Associated Intracerebral Hemorrhage: Clinical Outcome and Quality of Life Assessment

Neurosurgery ◽

10.1227/01.neu.0000144820.38439.63 ◽

2005 ◽

Vol 56 (1) ◽

pp. 12-20 ◽

Cited By ~ 69

Author(s):

Anthony L. D'Ambrosio ◽

Michael E. Sughrue ◽

Joshua G. Yorgason ◽

J D. Mocco ◽

Kurt T. Kreiter ◽

...

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Life Assessment ◽

Short Term ◽

Decompressive Hemicraniectomy ◽

Poor Grade

Abstract OBJECTIVE: Decompressive hemicraniectomy has been proposed as a potential treatment strategy in patients with poor-grade aneurysmal subarachnoid hemorrhage presenting with focal intracerebral hemorrhage causing significant mass effect. Although hemicraniectomy improves overall survival rates, the long-term quality of life (QoL) for survivors in this patient population has not been reported. METHODS: Using adjudicated outcome assessments, we compare long-term clinical outcomes and QoL between a group of patients with poor-grade aneurysmal subarachnoid hemorrhage receiving decompressive hemicraniectomy (n = 12) and a control group of similar patients managed more conservatively (n = 10). RESULTS: Patients receiving decompressive hemicraniectomy experienced a statistically insignificant decrease in short-term mortality compared with controls (25 versus 42%); however, long-term QoL in hemicraniectomy survivors was generally poor. Furthermore, hemicraniectomy patients did not experience an increase in mean quality-adjusted life years over control patients (2.31 versus 2.22 yr). CONCLUSION: Decompressive hemicraniectomy prolongs short-term survival in patients with poor-grade aneurysmal subarachnoid hemorrhage with associated intracerebral hemorrhage; however, this trend is not statistically significant, and the overall QoL experienced by survivors is poor. Decompressive hemicraniectomy may be indicated if performed early in a select subset of patients. On the basis of our preliminary data, large prospective studies to investigate this issue further may not be warranted.

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Low-Dose Intravenous Heparin Infusion After Aneurysmal Subarachnoid Hemorrhage is Associated With Decreased Risk of Delayed Neurological Deficit and Cerebral Infarction

Neurosurgery ◽

10.1093/neuros/nyaa473 ◽

2020 ◽

Author(s):

Matthew J Kole ◽

Aaron P Wessell ◽

Beatrice Ugiliweneza ◽

Gregory J Cannarsa ◽

Enzo Fortuny ◽

...

Keyword(s):

Logistic Regression ◽

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Low Dose ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neurological Deficits ◽

Comparison Analysis ◽

Cohort Comparison ◽

Multivariable Logistic Regression ◽

Intravenous Heparin

Abstract BACKGROUND Patients who survive aneurysmal subarachnoid hemorrhage (aSAH) are at risk for delayed neurological deficits (DND) and cerebral infarction. In this exploratory cohort comparison analysis, we compared in-hospital outcomes of aSAH patients administered a low-dose intravenous heparin (LDIVH) infusion (12 U/kg/h) vs those administered standard subcutaneous heparin (SQH) prophylaxis for deep vein thrombosis (DVT; 5000 U, 3 × daily). OBJECTIVE To assess the safety and efficacy of LDIVH in aSAH patients. METHODS We retrospectively analyzed 556 consecutive cases of aSAH patients whose aneurysm was secured by clipping or coiling at a single institution over a 10-yr period, including 233 administered the LDIVH protocol and 323 administered the SQH protocol. Radiological and outcome data were compared between the 2 cohorts using multivariable logistic regression and propensity score-based inverse probability of treatment weighting (IPTW). RESULTS The unadjusted rate of cerebral infarction in the LDIVH cohort was half that in SQH cohort (9 vs 18%; P = .004). Multivariable logistic regression showed that patients in the LDIVH cohort were significantly less likely than those in the SQH cohort to have DND (odds ratio (OR) 0.53 [95% CI: 0.33, 0.85]) or cerebral infarction (OR 0.40 [95% CI: 0.23, 0.71]). Analysis following IPTW showed similar results. Rates of hemorrhagic complications, heparin-induced thrombocytopenia and DVT were not different between cohorts. CONCLUSION This cohort comparison analysis suggests that LDIVH infusion may favorably influence the outcome of patients after aSAH. Prospective studies are required to further assess the benefit of LDIVH infusion in patients with aSAH.

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