Admission to a neurologic/neurosurgical intensive cave unit is associated with reduced mortality rate after intracerebral hemorrhage

Objective: To determine whether mortality rate after intracerebral hemorrha ge (ICH) is lower in patients admitted to a neurologic or neurosurgical (ne uro) intensive care unit (ICU) compared to those admitted to general ICUs. Background: The utility of specialty ICUs is debated. From a cost perspecti ve, having fewer larger ICUs is preferred. Alternatively, the impact of spe cialty ICUs on patient outcome is unknown. Patients with ICH are admitted r outinely to both general and neuro ICUs and provide an opportunity to addre ss this question. Setting: Forty-two neuro, medical, surgical, and medical-surgical ICUs. Measurements and Main Results: The study was an analysis of data prospectiv ely collected by Project Impact over 3 yrs from 42 participating ICUs (incl uding one neuro ICU) across the country. The records of 36,986 patients wer e merged with records of 3,298 patients from a second neuro ICU that collec ted the same data over the same period. The impact of clinical (age, race, gender, Glasgow Coma Scale score, reason for admission, insurance), ICU (si ze, number of ICH patients, full-time intensivist, clinical service, Americ an College for Graduate Medical Education or Critical Care Medicine fellows hip), and institutional (size, location, medical school affiliation) charac teristics on hospital mortality rate of ICH patients was assessed by using a forward-enter multivariate analysis. Data from 1,038 patients were includ ed. The 13 ICUs that admitted >20 patients accounted for 83% of the admissi ons with a mortality rate that ranged from 25% to 64%. Multivariate analysi s adjusted for patient demographics, severity of ICH, and ICU and instituti onal characteristics indicated that not being in a neuro ICU was associated with an increase in hospital mortality rate (odds ratio [OR], 3.4; 95% con fidence interval [CI], 1.65-7.6). Other factors associated with higher mort ality rate were greater age (OR, 1.03/year; 95% CI, 1.01-1.04), lower Glasg ow Coma Scale score (OR, 0.6/point; 95% CI, 0.58-0.65), fewer ICH patients (OR, 1.01/patient; 95% CI, 1.00-1.01), and smaller ICU (OR, 1.1/bed; 95% CI , 1.02-1.13). Having a full time intensivist was associated with lower mort ality rate (OR, 0.388; 95% Ct, 0.22-0.67). Conclusions:For patients with acute ICH, admission to a neuro vs. general I CU is associated with reduced mortality rate.