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dc.contributor.authorTran, Quincy K.
dc.contributor.authorNajafali, Daniel
dc.contributor.authorTiffany, Laura
dc.contributor.authorTanveer, Safura
dc.contributor.authorAndersen, Brooke
dc.contributor.authorDawson, Michelle
dc.contributor.authorHausladen, Rachel
dc.contributor.authorJackson, Matthew
dc.contributor.authorMatta, Ann
dc.contributor.authorMitchell, Jordan
dc.contributor.authorYum, Christopher
dc.contributor.authorKuhn, Diane
dc.date.accessioned2021-04-15T13:49:07Z
dc.date.available2021-04-15T13:49:07Z
dc.date.issued2021-01-12
dc.identifier.urihttp://hdl.handle.net/10713/15414
dc.description.abstractIntroduction: Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients' hospital stay. Methods: We retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes. Results: We analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 (14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBPSD), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005-1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15-0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients' likelihood to be discharged home. Conclusion: Our study suggests that greater SBPSD during patients' ED stay is associated with higher likelihood of AKI, while starting nicardipine infusion is associated with lower odds of in-hospital mortality. Further studies about interventions and outcomes of patients with sICH in the ED are needed to confirm our observations. © 2021 Tran et al.en_US
dc.description.urihttps://doi.org/10.5811/WESTJEM.2020.9.48072en_US
dc.language.isoenen_US
dc.publishereScholarshipen_US
dc.relation.ispartofWestern Journal of Emergency Medicineen_US
dc.subjectblood pressure variabilityen_US
dc.subjectexternal ventricular drainen_US
dc.subject.meshAcute Kidney Injuryen_US
dc.subject.meshBlood Pressureen_US
dc.subject.meshIntracranial Hemorrhagesen_US
dc.subject.meshEmergency Medical Servicesen_US
dc.titleEffect of blood pressure variability on outcomes in emergency patients with intracranial hemorrhageen_US
dc.typeArticleen_US
dc.identifier.doi10.5811/WESTJEM.2020.9.48072
dc.source.volume22
dc.source.issue2
dc.source.beginpage177
dc.source.endpage185


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