Early Predictors of Prolonged Stay in the Intensive Care Unit Following Intracerebral hemorrhage Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) is a neurologic emergency that typically requires monitoring in the intensive care unit (ICU). While the ICH score provides an early measure of hemorrhage severity, this study investigates its potential to predict ICU length of stay (LOS), alongside other clinical variables.

Methods: Retrospective analysis of ICH patients admitted to our tertiary center (2018-2023) included demographics, clinical exam characteristics, CT scans, intubation status, and neurosurgical procedures at presentation. We included all patients with ICH, while excluding those with a terminal injury at presentation. ICU LOS was the primary outcome, calculated from ICU admission to discharge. We utilized a multivariate ordinal regression model to identify independent predictors of ICU stay in ICH patients, including ICH score, neurological interventions, intubation, and complications.

Results: In our cohort of 251 ICH patients, the average ICU stay was 8.0 ± 11.1 days. On multivariate analysis, neurological interventions independently predicted longer ICU LOS: external ventricular drain placement (hazard ratio [HR] 2.39, 95 % confidence interval [CI] 1.34–3.43; p < 0.01), craniectomies (HR 1.19, CI 0.20–2.17; p = 0.018). Additionally, complicated ICU course was a significant predictor of LOS: septal shift (HR 0.78, CI 0.17–1.40; p = 0.012) mechanical ventilation (HR 2.00, CI 1.25–2.76; p < 0.01) and pneumonia (HR 1.92, CI 1.11–2.73; p < 0.01). Unexpectedly, ICH score was not a significant predictor of ICU LOS (HR -0.069, CI -0.34–0.020; p = 0.62)

Conclusion : Protracted ICU stay is better predicted by the need for invasive neurological interventions and the complexity of the clinical course rather than the severity of hemorrhage on early assessment as quantified by the ICH score.