Decreased Odds for Vasospasm Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage After Transitioning from Neurosurgery-Led Care to a Neurology-Led Multidisciplinary Approach (P5.9-046)

Objective: To describe differences in outcomes of patients with aneurysmal subarachnoid hemorrhages (aSAH) after a transition from a neurosurgery-led intensive care unit (ICU) to neurology-led multidisciplinary care in the neuro-critical care unit (NCCU). Background: Few studies exist that compare management approaches for aSAH. The limited research on aSAH assessed the efficacy of neuro-intensivist-led care on outcomes but no prior studies have compared the number of trips to interventional radiology (IR) for vasospasm treatment by management approach in aSAH patients. Design/Methods: We included patients (≥18) with aSAHs from 1/16–8/16 (pre-group) and from 3/17–11/17 (post-group). Pre-group care was led by a neurosurgeon. Post-group care included a neurologist, a pulmonary intensivist, a neurocritical care clinical nurse specialist, and a neurosurgeon. A euvolemia protocol was initiated for post-group care. The primary outcome was number of trips to interventional radiology (IR) for vasospasm treatment. Secondary outcomes were: vasospasm, mortality, mRS, and ischemic stroke. Data were analyzed using univariate analyses and multivariable ordinal logistic regression. Results: There were 99 patients with an aSAH included; 50 were in the pre-group and 49 were in the post-group. On average, patients in the post-group were 7 years older than the pre-group (p=0.05); there were no other significantly different demographic or clinical characteristics. The post-group was 62% less likely to have a higher number of trips to IR for vasospasm treatment, when compared to the pre-group, p Conclusions: In patients with aSAH, the neurology-led multidisciplinary care in the NCCU decreased the odds of repeated procedures for vasospasm treatment. Other outcomes maintained comparable to the prior neurosurgical-led care in the ICU. This may reduce the financial burden of hospitalization and lower utilization of scarce hospital resources. The neurology-led multidisciplinary care could be more cost-effective than the neurosurgical-led care. Disclosure: Dr. Bartt has nothing to disclose. Dr. Jarvis has nothing to disclose. Dr. Cittadino has nothing to disclose. Dr. Atchie has nothing to disclose. Dr. McCarthy has nothing to disclose. Dr. van Vliet has nothing to disclose. Dr. Price has nothing to disclose. Dr. Bennett has nothing to disclose. Dr. Wagner has nothing to disclose. Dr. Orlando has nothing to disclose. Dr. Bar-Or has nothing to disclose.