Should mild or moderate stroke patients be admitted to an intensive care unit?

Deborah E. Briggs, Robert A. Felberg, Marc D. Malkoff, Patti Bratina, James C. Grotta

Research output: Contribution to journalArticle

71 Scopus citations

Abstract

Background and Purpose - Inhospital placement of patients with mild (National Institutes of Health Stroke Scale [NIHSS] score <8) or moderate (NIHSS 8 through 16) acute strokes is variable. We assessed the outcome of such patients based on intensive care unit (ICU) versus general ward placement. Methods - We reviewed 138 consecutive patients admitted within 24 hours of stroke onset to 2 physically adjacent hospitals with different admitting practices. Outcome measures included complication rates, discharge Rankin scale score, hospital discharge placement, costs, and length of stay (LOS). Results - Hospital A, a 626-bed university-affiliated hospital, admitted 43% of mild and moderate strokes (MMS) to an ICU (26% of mild, 74% of moderate), whereas hospital B, a 618-bed community facility, admitted 18% of MMS to an ICU (3% of mild, 45% of moderate; P<0.004). There were no significant differences in outcomes between the 2 hospitals. Analysis of only patients admitted to hospital A, and of all patients, demonstrated that mild stroke patients admitted to the general ward had fewer complications and more favorable discharge Rankin scale scores than similar patients admitted to an ICU. There was no statistically significant difference in LOS, but total room costs for a patient admitted first to the ICU averaged $15 270 versus $3638 for admission directly to the ward. Conclusions - While limited by the retrospective nature of our study, routinely admitting acute MMS patients to an ICU provides no cost or outcomes benefits.

Original languageEnglish (US)
Pages (from-to)871-876
Number of pages6
JournalStroke
Volume32
Issue number4
DOIs
StatePublished - Jan 1 2001

Keywords

  • Costs and cost analysis
  • Stroke
  • Stroke management
  • Stroke outcome
  • Triage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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  • Cite this

    Briggs, D. E., Felberg, R. A., Malkoff, M. D., Bratina, P., & Grotta, J. C. (2001). Should mild or moderate stroke patients be admitted to an intensive care unit? Stroke, 32(4), 871-876. https://doi.org/10.1161/01.STR.32.4.871