Abstract TP124: Early Neurological Improvement Can Reduce Intensive Care Unit Length Of Stay In Aneurysmal Subarachnoid Hemorrhage

Abstract

Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) is often accompanied by an extended length of stay (LOS) in the intensive care unit (ICU), at tremendous cost to both the hospital system and the patient. We sought to determine predictors for ICU LOS in these patients. Methods: We performed a retrospective study of a cohort of consecutive patients with aSAH admitted to an academic referral center from 2016 to 2021. Multiple linear regression was performed in survivors to identify predictors for ICU LOS among factors present on admission and those related to hospital course. Results: In a cohort of 306 patients with confirmed aSAH, mean age was 57 years (SD 13.7), 61% were female and 70% were white. ICU LOS was longer for survivors (median 19 days, IQR 14-25) than for non-survivors (median 5 days, IQR 2-8; p<0.001). For survivors (n=210), admission-related factors including Hunt and Hess grades 4 or 5 (4 additional days, 95% CI 0.5-7.5; p=0.027), hydrocephalus with external ventricular drain (EVD) requirement (9.2 additional days, 95% CI 5.7-12.8; p<0.001), and coagulopathy (3.2 additional days, 95% CI 0.9-6.2; p=0.03) were associated with longer ICU LOS; however, early neurological improvement (defined as decrease in Hunt and Hess grades within first 3 days of admission) was associated with shorter ICU LOS (5.4 fewer days, 95% CI 2.7-8.5; p=0.001). Among hospital-related factors, symptomatic vasospasm (3.2 additional days, 95% CI 1.9-6.5; p=0.016), pneumonia (5.7 additional days, 95% CI 3.5-9.4; p= 0.001), and laryngeal edema requiring intubation or reintubation (4.3 additional days, 95% CI 0.7-7.8; p<0.001) were associated with prolonged ICU LOS. Laboratory values from the emergency department and past medical history were not predictive for ICU LOS. Conclusion: Admission-related factors and in-hospital complications were more predictive for prolonged ICU LOS than past medical history or any laboratory values on admission. Early neurological improvement was associated with shorter ICU LOS which underscores the importance of early aggressive treatment measures in patients with aSAH.