Abstract | 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:
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Authors | Ali Alaraj, Darian R Esfahani, Ahmed E Hussein, Ioana Darie, Sepideh Amin-Hanjani, Konstantin V Slavin, Xinjian Du, Fady T Charbel |
Journal | Neurosurgery
(Neurosurgery)
Vol. 81
Issue 2
Pg. 240-250
(Aug 01 2017)
ISSN: 1524-4040 [Electronic] United States |
PMID | 28327914
(Publication Type: Journal Article)
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Copyright | Copyright © 2017 by the Congress of Neurological Surgeons |
Chemical References |
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Topics |
- Anticoagulants
- Cerebral Hemorrhage
- Emergency Medical Services
(statistics & numerical data)
- Humans
- Hydrocephalus
- Neurosurgical Procedures
(mortality, statistics & numerical data)
- Patient Transfer
(statistics & numerical data)
- Retrospective Studies
- Risk Factors
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