J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 3, March 2018, pages 174-177

Do All Acute Stroke Patients Receiving tPA Require ICU Admission?

Figure 1. Outcome comparisons between the low risk monitor (LRM) and active treatment (AT) groups.

**Table 1.** Active Life Supporting Treatments
AV pacing	Endoscopies	PA catheter
AV: atrioventricular; CRRT: continuous renal replacement therapy; ECMO: extracorporeal membrane oxygenation; HFOV: high frequency oscillatory ventilation; IPPV: intermittent positive pressure ventilation; IRRT/HD: intermittent renal replacement therapy/hemodialysis; IV: intravenous; NIPPV (BiPAP): non-invasive positive pressure ventilation (Bilevel positive airway pressure); PA: pulmonary artery; Tx: treatment; VAD: ventricular assist device.
Barbiturate anesthesia	HFOV	Post-arrest
Cardioversion	Induced hypothermia	Prone positioning
Continuous antiarrythmic	IABP	Rapid blood transfusion
Continuous arterial drug infusion	IPPV	Reintubation within 24 h
Continuous neuromuscular blockade	IRRT/HD	Vasoactive drug infusion
CRRT	IV replacement excessive fluid loss	Tx of status epilepticus
ECMO	IV vasopressin	VAD
Emergency procedure inside ICU	Intubation in ICU	Vasoactive > one
Emergency procedure outside ICU	NIPPV (BiPAP)	Ventriculostomy

Table 1. Active Life Supporting Treatments

AV pacing

Endoscopies

PA catheter

AV: atrioventricular; CRRT: continuous renal replacement therapy; ECMO: extracorporeal membrane oxygenation; HFOV: high frequency oscillatory ventilation; IPPV: intermittent positive pressure ventilation; IRRT/HD: intermittent renal replacement therapy/hemodialysis; IV: intravenous; NIPPV (BiPAP): non-invasive positive pressure ventilation (Bilevel positive airway pressure); PA: pulmonary artery; Tx: treatment; VAD: ventricular assist device.

Barbiturate anesthesia

HFOV

Post-arrest

Cardioversion

Induced hypothermia

Prone positioning

Continuous antiarrythmic

IABP

Rapid blood transfusion

Continuous arterial drug infusion

IPPV

Reintubation within 24 h

Continuous neuromuscular blockade

IRRT/HD

Vasoactive drug infusion

CRRT

IV replacement excessive fluid loss

Tx of status epilepticus

ECMO

IV vasopressin

VAD

Emergency procedure inside ICU

Intubation in ICU

Vasoactive > one

Emergency procedure outside ICU

NIPPV (BiPAP)

Ventriculostomy

**Table 2.** Patient Data Collected and Variables Used for Predicting Risk for Active Treatment Based on Intensive Care Unit Day 1 Data
Age	Continuous measure plus five spline terms
*The APS is a sum of weights assigned to 17 physiologic variables. The weights are determined by the most abnormal value for a measurement within first day in intensive care unit. Variables include pulse rate, mean blood pressure, temperature, respiratory rate, PaO₂/FiO₂ ratio (or P(Aa)O₂) for intubated patients with FiO₂ N.5), hematocrit, white blood cell count, creatinine, urine output, blood urea nitrogen, sodium, albumin, bilirubin, glucose, acid base status, and neurological abnormalities based on Glasgow coma score.
Chronic health variables	Y/N for the following variables: AIDS, hepatic failure, lymphoma, metastatic tumor, immunosuppression, leukemia or myeloma, and cirrhosis. Not used for elective surgery patients.
ICU admission source	Floor, emergency room, operating/recovery room, step down unit, direct admission, other ICU, other hospital, other admission source
ICU admission diagnosis	116 categories, leading to 115 indicator variables (“acute myocardial infarction, other location” is the reference category).
Length of stay before ICU admission	Square root of time in minutes between hospital admission and ICU admission. This is a continuous measure, and four spline terms are added.
Unable to assess Glasgow coma score due to sedation or paralysis	Y/N
Emergency surgery	Y/N
Mechanical ventilation on first ICU day	Y/N
Thrombolytic therapy	Y/N (for patients with acute myocardial infarction)
ICU readmission	Y/N
Glasgow coma score rescaled	15 minus measured Glasgow coma score
PaO₂/FiO₂ ratio rescaled
APS*	Continuous measure plus five spline terms

Table 2. Patient Data Collected and Variables Used for Predicting Risk for Active Treatment Based on Intensive Care Unit Day 1 Data

Age

Continuous measure plus five spline terms

*The APS is a sum of weights assigned to 17 physiologic variables. The weights are determined by the most abnormal value for a measurement within first day in intensive care unit. Variables include pulse rate, mean blood pressure, temperature, respiratory rate, PaO₂/FiO₂ ratio (or P(Aa)O₂) for intubated patients with FiO₂ N.5), hematocrit, white blood cell count, creatinine, urine output, blood urea nitrogen, sodium, albumin, bilirubin, glucose, acid base status, and neurological abnormalities based on Glasgow coma score.

Chronic health variables

Y/N for the following variables: AIDS, hepatic failure, lymphoma, metastatic tumor, immunosuppression, leukemia or myeloma, and cirrhosis. Not used for elective surgery patients.

ICU admission source

Floor, emergency room, operating/recovery room, step down unit, direct admission, other ICU, other hospital, other admission source

ICU admission diagnosis

116 categories, leading to 115 indicator variables (“acute myocardial infarction, other location” is the reference category).

Length of stay before ICU admission

Square root of time in minutes between hospital admission and ICU admission. This is a continuous measure, and four spline terms are added.

Unable to assess Glasgow coma score due to sedation or paralysis

Y/N

Emergency surgery

Y/N

Mechanical ventilation on first ICU day

Y/N

Thrombolytic therapy

Y/N (for patients with acute myocardial infarction)

ICU readmission

Y/N

Glasgow coma score rescaled

15 minus measured Glasgow coma score

PaO₂/FiO₂ ratio rescaled

APS*

Continuous measure plus five spline terms

**Table 3.** Baseline Characteristics and Outcomes of the Active Treatment Group and the Low Risk Monitor Group
	Active treatment	LRM	P value
No. of ICU admissions	59	21
Age (mean ± SD)	75 ± 13	72 ± 17	0.4
APACHE III (mean ± SD)	62 ± 26	41 ± 15	0.0008
Pre-tPA-NIHSS (mean ± SD)	16 ± 9	14 ± 8	0.4
Hospital mortality, n (%)	21 (36)	1 (4.7)	0.006
ICU mortality, n (%)	13 (22)	1 (4.7)	0.07
ICU LOS (mean days ± SD)	4.5 ± 4.4	2.5 ± 1.3	0.04

Table 3. Baseline Characteristics and Outcomes of the Active Treatment Group and the Low Risk Monitor Group

Active treatment

LRM

P value

No. of ICU admissions

Age (mean ± SD)

75 ± 13

72 ± 17

0.4

APACHE III (mean ± SD)

62 ± 26

41 ± 15

0.0008

Pre-tPA-NIHSS (mean ± SD)

16 ± 9

14 ± 8

0.4

Hospital mortality, n (%)

21 (36)

1 (4.7)

0.006

ICU mortality, n (%)

13 (22)

1 (4.7)

0.07

ICU LOS (mean days ± SD)

4.5 ± 4.4

2.5 ± 1.3

0.04