Joshua Olexa
University of Maryland Department of Neurosurgery
Baltimore, MD
Disclosure information not submitted.
Hammad Baqai, n/a
Student
University of Maryland Research Associate Program, United States
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Hannah Frederick, BS
Student
University of Maryland Research Associate Program, United States
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Julianna Solomon, BS
Student
University of Maryland Research Associate Program, United States
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Ayah Aligabi, n/a
Student
University of Maryland Research Associate Program, United States
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Richa Beher, BS
Student
University of Maryland Research Associate Program, United States
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Vera Bzhilyanskaya, BS
Student
University of Maryland Research Associate Program
College Park, Maryland, United States
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Jesse Stokum, MD
Resident
University of Maryland Department of Neurosurgery, United States
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Ashish Sharma, MD
Resident
University of Maryland Department of Neurosurgery, United States
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Austin Widjaja
Student
1The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Grace Hollis, n/a
Student
University of Maryland Research Associate Program, United States
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Maie Abdel-Wahab, n/a
Student
University of Maryland Research Associate Program, United States
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Zain Alam, n/a
Student
University of Maryland Research Associate Program, United States
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Matthew Fairchild, n/a
Student
University of Maryland Research Associate Program, United States
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Fatima Mikdashi, BS
Student
University of Maryland Research Associate Program, United States
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Iana Sahadzic, n/a
Student
University of Maryland Research Associate Program, United States
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Isha Yardi, n/a
Student
University of Maryland Research Associate Program, United States
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Kaitlyn Tang, n/a
Student
University of Maryland Research Associate Program, United States
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Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
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Title: Outcome in Intracranial Hypertension From Spontaneous Hemorrhage: Blood Pressure Variability Matters
Introduction: Spontaneous Intracerebral hemorrhage (sICH) is a complex and devastating disease state that causes significant patient morbidity and mortality, it is also challenging for neurosurgical and intensive care teams to manage. Previous studies showed Blood Pressure Variability (BPV) was associated with patients’ poor outcome, however, there is insufficient literature about outcomes and BPV in patients who had intracranial hypertension from sICH.
Methods: This was a retrospective study involving adult patients suffering from sICH who underwent External Ventricular Drain (EVD) placement at a quaternary academic center from 01/01/2016- 12/31/2020. We excluded patients with subarachnoid or traumatic intracerebral hemorrhage. Outcomes were in-hospital mortality and being discharged home, which is an indicator of good functional outcome. We used the Classification And Regression Tree (CART), which is a machine learning algorithm, to identify clinical factors that were significantly associated with patients’ outcome. The CART algorithm used recursive partition to create a decision tree showing factors associated with outcomes. Variables with significant association with outcomes were expressed as Relative Variable Importance (RVI), the most important factor would be assigned 100% and subsequent factors are assigned percentages with respect to the top predictor.
Results: We analyzed 187 patients’ records. Mean age and opening pressure was 58±14 years, 21±8 centimeter of water (cm H2O) respectively, median ICH score was 2 [Interquartile 2-3]. 55 (29%) patients died and 14 (7%) were discharged home. For mortality, 24-hour Glasgow Coma Scale (GCS) was most important factor (RVI 100%), then highest systolic blood pressure (SBP) (RVI 54%), lowest SBP (RVI 45%). For discharge home, important factors were 24-hour GCS (RVI 100%), admission serum glucose (RVI 99%), ICH score (RVI 87%), Age (RVI 58%) and successive variation of SBP (SBPSV) (RVI 54%).
Conclusion: In our study, patient’s clinical factors were important, while components of blood pressure variability were moderately important, to patients’ mortality and functional outcome. Until further studies are available, clinicians should prevent too high or too low SBP and high variability of blood pressure among these critically ill patients.