2023
Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage
Hwang D, Kim K, Muehlschlegel S, Wartenberg K, Rajajee V, Alexander S, Busl K, Creutzfeldt C, Fontaine G, Hocker S, Madzar D, Mahanes D, Mainali S, Sakowitz O, Varelas P, Weimar C, Westermaier T, Meixensberger J. Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage. Neurocritical Care 2023, 40: 395-414. PMID: 37923968, PMCID: PMC10959839, DOI: 10.1007/s12028-023-01854-7.Peer-Reviewed Original ResearchClinical grading scaleClinical variablesGrading scaleRecommendations AssessmentPoor outcomeIntensive care unit admissionCandidate clinical variablesCritically Ill AdultsIndividual clinical variablesMajor clinical predictorsCare unit admissionCounseling of patientsBest practice statementsJudgment of prognosisNarrative systematic reviewConclusionsThese guidelinesUnit admissionNeurological recoveryClinical predictorsIll adultsCounseling patientsIntracerebral hemorrhageFunctional outcomeConsensus statementNeuroprognosticationEmergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa
Ammar A, Elsamadicy A, Ammar M, Reeves B, Koo A, Falcone G, Hwang D, Petersen N, Kim J, Beekman R, Prust M, Magid-Bernstein J, Acosta J, Herbert R, Sheth K, Matouk C, Gilmore E. Emergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa. Clinical Neurology And Neurosurgery 2023, 226: 107621. PMID: 36791588, DOI: 10.1016/j.clineuro.2023.107621.Peer-Reviewed Original ResearchConceptsAndexanet alfaExtra-axial hemorrhageEVD placementThrombotic eventsNew hemorrhagePrimary safety outcomeExternal ventricular drain placementLarge prospective studiesIntensive care unitIntracerebral hemorrhage patientsVentricular drain placementBolus patientsHospital lengthHospital LOSICU LOSTract hemorrhageRankin scoreSecondary outcomesAdult patientsBolus groupPrimary outcomeCare unitIntracerebral hemorrhageLong administration timeHemorrhage patients
2022
Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury
Muehlschlegel S, Goostrey K, Flahive J, Zhang Q, Pach JJ, Hwang DY. Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury. Neurology 2022, 99: e1446-e1455. PMID: 35853748, PMCID: PMC9576301, DOI: 10.1212/wnl.0000000000200937.Peer-Reviewed Original ResearchConceptsCode status changeTraumatic brain injuryBrain injuryIschemic strokeCare decisionsIntracerebral hemorrhageDA groupAcute brain injury patientsSevere acute brain injuryNeurologic intensive care unitCare decision aidSurrogates of patientsAcute brain injuryAcute ischemic strokeClass IV evidenceLong-term prognosisIntensive care unitBrain injury patientsClinician-family communicationAdditional psychosocial supportPatient-centered careLife-sustaining treatmentPsychological outcomesDecision-making interventionClassification of evidence
2021
Adapting a Traumatic Brain Injury Goals-of-Care Decision Aid for Critically Ill Patients to Intracerebral Hemorrhage and Hemispheric Acute Ischemic Stroke
Goostrey KJ, Lee C, Jones K, Quinn T, Moskowitz J, Pach JJ, Knies AK, Shutter L, Goldberg R, Mazor KM, Hwang DY, Muehlschlegel S. Adapting a Traumatic Brain Injury Goals-of-Care Decision Aid for Critically Ill Patients to Intracerebral Hemorrhage and Hemispheric Acute Ischemic Stroke. Critical Care Explorations 2021, 3: e0357. PMID: 33786434, PMCID: PMC7994105, DOI: 10.1097/cce.0000000000000357.Peer-Reviewed Original ResearchAcute ischemic strokeCare decision aidIschemic strokeNeurologic ICUIntracerebral hemorrhageIll patientsIll traumatic brain injury patientsTraumatic brain injury patientsInternational Patient Decision Aid StandardsDisease-specific prognosisProspective observational studyBrain injury patientsIntracerebral Hemorrhage ScorePatient decision aidCare decision supportDecision aidDisease-specific dataOutcome prediction modelsDecision aid contentFamily membersHemorrhagic strokeInjury patientsFeasibility trialPatient prognosisObservational study
2020
The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage.
Reznik ME, Moody S, Murray K, Costa S, Grory BM, Madsen TE, Mahta A, Wendell LC, Thompson BB, Rao SS, Stretz C, Sheth KN, Hwang DY, Zahuranec DB, Schrag M, Daiello LA, Asaad WF, Jones RN, Furie KL. The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage. Neurology 2020, 95: e2727-e2735. PMID: 32913011, PMCID: PMC7734724, DOI: 10.1212/wnl.0000000000010738.Peer-Reviewed Original ResearchConceptsImpact of deliriumIntracerebral hemorrhageLife-sustaining treatmentScore-based modelSingle-center cohort studyCox regression modelCharacteristic curve analysisDSM-5 criteriaHospital daysCohort studyConsecutive patientsMedian timeDelirium groupPoor outcomeDeliriumWLSTPatientsLogistic regressionCurve analysisHemorrhage
2018
Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage
Ormseth CH, Falcone GJ, Jasak SD, Mampre DM, Leasure AC, Miyares LC, Hwang DY, James ML, Testai FD, Becker KJ, Tirschwell DL, Langefeld CD, Woo D, Sheth KN. Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage. Neurocritical Care 2018, 29: 419-425. PMID: 29949003, PMCID: PMC6286261, DOI: 10.1007/s12028-018-0554-4.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageHematoma volumeAdmission Glasgow Coma ScaleEthnic/Racial VariationsNon-traumatic intracerebral hemorrhageIntracerebral Hemorrhage (ERICH) studyProspective cohort studyGlasgow Coma ScaleIntensive care unitWithdrawal of careSpontaneous intracerebral hemorrhageSimilar mortality ratesLogistic regression analysisRace/ethnicity modifiesRace/ethnicityCMO patientsHospital mortalityCohort studyRankin ScaleWhite patientsComa ScaleBlack patientsCare unitEndotracheal intubationICH patients
2017
Variability in Gastrostomy Tube Placement for Intracerebral Hemorrhage Patients at US Hospitals
Hwang DY, George BP, Kelly AG, Schneider EB, Sheth KN, Holloway RG. Variability in Gastrostomy Tube Placement for Intracerebral Hemorrhage Patients at US Hospitals. Journal Of Stroke And Cerebrovascular Diseases 2017, 27: 978-987. PMID: 29221969, DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.001.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCerebral HemorrhageClinical Decision-MakingDatabases, FactualFemaleGastrostomyHealthcare DisparitiesHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPractice Patterns, Physicians'Process Assessment, Health CareRetrospective StudiesTime FactorsUnited StatesYoung AdultConceptsGastrostomy tube placementTube placementGastrostomy tubeICH patientsIntracerebral hemorrhageUS hospitalsMultilevel multivariable regression modelsHospital random effectsNationwide Inpatient SampleIntracerebral hemorrhage patientsMultivariable regression modelsLocal practice patternsMedian odds ratioICH hospitalizationsHospital factorsHospital covariatesRegression modelsHemorrhage patientsICH admissionsInpatient SampleOdds ratioPlacement ratesPractice patternsMedian increasePatientsFactors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes
Hwang DY, Chu SY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME, Rosand J, Battey TWK, Koch S, Perez ML, James ML, McFarlin J, Osborne JL, Woo D, Kittner SJ, Sheth KN. Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes. Neurocritical Care 2017, 27: 316-325. PMID: 28744847, DOI: 10.1007/s12028-017-0430-7.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageRadiographic factorsMethodsThis prospective observational studyClinical scalesPre-existing comorbiditiesProspective observational studyIntracerebral hemorrhage outcomesSubjective clinical judgmentJudgment of physiciansRankin ScaleICH patientsFunctional outcomeUS CentersObservational studyPrognostic scalesClinical teamClinical judgmentFUNC scoreNursesPhysiciansExamination componentsPatientsOutcomesPrognosticationClinicians
2015
Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes
Hwang DY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME, Rosand J, Battey TW, Koch S, Perez ML, James ML, McFarlin J, Osborne JL, Woo D, Kittner SJ, Sheth KN. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology 2015, 86: 126-133. PMID: 26674335, PMCID: PMC4731687, DOI: 10.1212/wnl.0000000000002266.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleICH scoreIntracerebral hemorrhageSubjective clinical judgmentFUNC scorePhysicians' predictionsPrognostic scalesClinical teamClinical judgmentUS tertiary care centerPatient's clinical teamTertiary care centerProspective observational studyIntracerebral hemorrhage outcomesSpontaneous intracerebral hemorrhageRankin ScaleComfort careICH patientsFunctional outcomeCare centerPatient admissionsObservational studyComfort measuresPrognostic instrumentNeurologic practice
2014
Subjective Judgments of Physicians and Nurses Are More Accurate Than Formal Clinical Scales in Predicting Functional Outcome After Intracerebral Hemorrhage (S45.006)
Hwang D, Dell C, Sparks M, Watson T, Langefeld C, Comeau M, Rosand J, Battey T, Koch S, Perez M, James M, McFarlin J, Osborne J, Woo D, Kittner S, Sheth K. Subjective Judgments of Physicians and Nurses Are More Accurate Than Formal Clinical Scales in Predicting Functional Outcome After Intracerebral Hemorrhage (S45.006). Neurology 2014, 82 DOI: 10.1212/wnl.82.10_supplement.s45.006.Peer-Reviewed Original Research