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Outcomes and Costs of Patients Admitted to the ICU Due to Spontaneous Intracranial Hemorrhage

Fernando, Shannon M., MD, MSc1,2; Reardon, Peter M., MD1,2; Dowlatshahi, Dar, MD, PhD3,4; English, Shane W., MD, MSc1,4; Thavorn, Kednapa, PhD4,5; Tanuseputro, Peter, MD, MHSc4,6,7; Perry, Jeffrey J., MD, MSc2,4; Rosenberg, Erin, MD, MHA1; Wijdicks, Eelco F., MD, PhD8; Heyland, Daren K., MD, MSc9; Kyeremanteng, Kwadwo, MD, MHA1,4,7

doi: 10.1097/CCM.0000000000003013
Online Clinical Investigations
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Objectives: Spontaneous intracranial hemorrhage, including subarachnoid hemorrhage and intracerebral hemorrhage, is associated with significant morbidity and mortality. Although many of these patients will require ICU admission, little is known regarding their outcomes and the costs incurred. We evaluated this population in order to identify outcomes and cost patterns.

Design: Retrospective cohort analysis of a health administrative database.

Setting: Two ICUs within a single hospital system.

Patients: Eight-thousand four-hundred forty-seven patients admitted to ICU from 2011 to 2014, of whom 332 had a diagnosis of spontaneous intracranial hemorrhage. Control patients were defined as randomly selected age, sex, and comorbidity index–matched nonintracranial hemorrhage ICU patients (1:4 matching ratio).

Interventions: None.

Measurements and Main Results: Mean age of ICU intracranial hemorrhage patients was 60.1 years, and 120 (36.1%) died prior to discharge. Intracranial hemorrhage was associated with a mean total cost of $75,869, compared with $52,471 in control patients (p < 0.01). Mean cost per survivor of intracranial hemorrhage patients was $118,813. Subarachnoid hemorrhage was associated with significantly higher mean total costs than intracerebral hemorrhage ($92,794 vs $53,491; p < 0.01) and higher mean cost per day ($4,377 vs $3,604; p < 0.01). Patients with intracranial hemorrhage who survived to hospital discharge were significantly costlier than decedents ($100,979 vs $30,872; p < 0.01). Intracranial hemorrhage associated with oral anticoagulant use had a mean total cost of $152,373, compared with $66,548 in nonoral anticoagulant intracranial hemorrhage (p < 0.01).

Conclusions: Patients admitted to ICU with intracranial hemorrhage have high costs and high mortality, leading to elevated cost per survivor. Subarachnoid hemorrhage patients incur greater costs than intracerebral hemorrhage patients, and oral anticoagulant–associated intracerebral hemorrhage is particularly costly. Our findings provide novel information regarding financial impact of this common ICU population.

1Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

2Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

3Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

4Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

5School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

6Bruyere Research Institute, Ottawa, ON, Canada.

7Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

8Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.

9Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada.

Drs. Fernando, Reardon, Dowlatshahi, Thavorn, and Kyeremanteng designed the study. Drs. Reardon, Thavorn, Tanuseputro, Rosenberg, and Kyeremanteng gathered the data. Drs. Fernando, Dowlatshahi, English, Perry, Wijdicks, Heyland, and Kyeremanteng analyzed the data. Drs. Fernando, Reardon, Dowlatshahi, English, Thavorn, Tanuseputro, Perry, Rosenberg, Wijdicks, Heyland, and Kyeremanteng wrote the article and agreed to be responsible for its contents.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Dowlatshahi received funding from Bayer and BMS/Pfizer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: sfernando@toh.ca

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