Evidence map›Paper›PMID 32820377›Full record

ArticleActa neurochirurgica2021

Neurosurgical patients admitted via the emergency department initiating comfort care measures: a prospective cohort analysis.

Joseph R Linzey, Rachel Foshee, Sudharsan Srinivasan, Arjun R Adapa, Meghan L Wind, Carina Brake, Badih Junior Daou, Kyle Sheehan, Thomas C Schermerhorn, Teresa L Jacobs and 1 more

Abstract read
PubMed Publisher
In one paragraph

Article in Acta neurochirurgica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Effect of New Nursing on Patients with Acute Cerebral Infarction.Computational and mathematical methods in medicine · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Joseph R LinzeyDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Rachel FosheeDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Sudharsan SrinivasanUniversity of Michigan Medical School, Ann Arbor, MI, USA.
Arjun R AdapaUniversity of Michigan Medical School, Ann Arbor, MI, USA.
Meghan L WindDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Carina BrakeDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Badih Junior DaouDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Kyle SheehanDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Thomas C SchermerhornDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Teresa L JacobsDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA.
Aditya S PandeyDepartment of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338, USA. adityap@med.umich.edu.ORCID http://orcid.org/0000-0003-0789-4273

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGiven the serious nature of many neurosurgical pathologies, it is common for hospitalized patients to elect comfort care (CC) over aggressive treatment. Few studies have evaluated the incidence and risk factors of CC trends in patients admitted for neurosurgical emergencies.

objectivesTo analyze all neurosurgical patients admitted to a tertiary care academic referral center via the emergency department (ED) to determine incidence and characteristics of those who initiated CC measures during their initial hospital admission.

methodsWe performed a prospective, cohort analysis of all consecutive adult patients admitted to the neurosurgical service via the ED between October 2018 and May 2019. The primary outcome was the initiation of CC measures during the patient's hospital admission. CC was defined as cessation of life-sustaining measures and a shift in focus to maintaining the comfort and dignity of the patient.

resultsOf the 428 patients admitted during the 7-month period, 29 (6.8%) initiated CC measures within 4.0 ± 4.0 days of admission. Patients who entered CC were significantly more likely to have a medical history of cerebrovascular disease (58.6% vs. 33.3%, p = 0.006), dementia (17.2% vs. 1.5%, p = 0.0004), or cancer with metastatic disease (24.1% vs. 7.0%, p = 0.001). Patients with a presenting pathology associated with cerebrovascular disease were significantly more likely to initiate CC (62.1% vs. 35.3, p = 0.04). Patients who underwent emergent surgery were significantly more likely to enter CC compared with those who had elective surgery (80.0% vs. 42.7%, p = 0.02). Only 10 of the 29 (34.5%) patients who initiated CC underwent a neurosurgical operation (p = 0.002). Twenty of the 29 (69.0%) patients died within 0.8 ± 0.8 days after the initiation of CC measures.

conclusionCC measures were initiated in 6.8% of patients admitted to the neurosurgical service via the ED, with the majority of patients entering CC before an operation and presenting with a cerebrovascular pathology.

Indexed as

Emergency Medical ServicesNeurosurgical ProceduresPatient AdmissionAgedAged, 80 and overCohort StudiesElective Surgical ProceduresEmergency Service, HospitalFemaleHumansIncidenceMaleMiddle AgedPatient ComfortPatientsProspective StudiesComfort careEmergency departmentEmergent surgeryEnd-of-life careHospital admissionStroke

Identifiers

PMID32820377

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.