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Abstract
BACKGROUND To explore the effect of end of life and other palliative decision making scenarios on the mental health of family members of patients in the neuro-intensive care unit. METHODS Decision makers of patients in the neuro-ICU at a large, urban, academic medical center meeting palliative care triggers were identified from November 10, 2014, to August 27, 2015. Interviews were conducted at 1 and 6 months post-enrollment. At 1 month, the Inventory of Complicated Grief-Revised (ICG-R), Impact of Events Scale-Revised (IES-R), and the Family Satisfaction-ICU (FS-ICU) were performed along with basic demographic questionnaires. At 6 months, only the ICG-R and IES-R were repeated. RESULTS At 1 month, 9 (35%) subjects had significant symptoms in at least one of the three domains of traumatic response. Two (7.7%) subjects met full criteria for PTSD (IES-R ≥ 1.5). At 6 months, 5 (22%) subjects met criteria for PTSD and 5 (22%) for Complicated Grief (ICG-R ≥ 36). Fifteen (50%) had at least one domain of PTSD symptoms identified in follow-up. Time spent at bedside and lower household income were associated with PTSD at 1 and 6 months, respectively. In all, clinically significant psychological outcomes were identified in 9 (30%) of subjects. CONCLUSIONS Clinically significant grief and stress reactions were identified in 30% of decision makers for severely ill neuro-ICU patients. Though factors including time at bedside during hospitalization and total household income may have some predictive value for these disorders, further evaluation is required to help identify family members at risk of psychopathology following neuro-ICU admissions.
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Affiliation(s)
- Stephen A Trevick
- Division of Neurocritical Care, Department of Neurology, Northwestern University Mcgaw Medical Center, Chicago, IL, USA.
| | - Aaron S Lord
- Division of Neurocritical Care, Department of Neurology, NYU School of Medicine, New York, NY, USA
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Liotta EM, Prabhakaran S, Sangha RS, Bush RA, Long AE, Trevick SA, Potts MB, Jahromi BS, Kim M, Manno EM, Sorond FA, Naidech AM, Maas MB. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology 2017; 89:813-819. [PMID: 28747450 DOI: 10.1212/wnl.0000000000004249] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/31/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). METHODS Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. RESULTS We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate (p = 0.02), parsimoniously adjusted (p = 0.002), and fully adjusted models (p = 0.006), as well as greater hematoma growth (p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes (p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. CONCLUSIONS These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.
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Affiliation(s)
- Eric M Liotta
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL.
| | - Shyam Prabhakaran
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Rajbeer S Sangha
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Robin A Bush
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Alan E Long
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Stephen A Trevick
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Matthew B Potts
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Babak S Jahromi
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Minjee Kim
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Edward M Manno
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Farzaneh A Sorond
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Andrew M Naidech
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
| | - Matthew B Maas
- From the Departments of Neurology (E.M.L., S.P., R.S.S., R.A.B., A.E.L., S.A.T., M.K., E.M.M., F.A.S., A.M.N., M.B.M.) and Neurological Surgery (M.B.P., B.S.J.), Northwestern University, Chicago, IL
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