Recovery After Cerebral Hemorrhage--Improving Outcomes for Patients With Life-Threatening Neurologic Illness

The objective of the proposed minimal-risk, non-interventional retrospective (January 2012 onwards) as well as prospective, cross-sectional observational study (i.e., NCCU Research Repository) is to better understand the common pathophysiological pathways of life-threatening neurological illnesses, examine how systemic complications (e.g., fever, hyperglycemia, undernutrition, and infections) and our standard-of care management of them may exacerbate brain injury, and determine the impact of injury and intervention on functionally-relevant outcomes.

A systematically collected cohort may have an especially important role in the NCCU where RCTs are difficult to implement or may lack generalizability, and wherein there are pitfalls in research derived solely from administrative databases. This relational database will capture all patients admitted to University of Maryland's dedicated 22-bed adult NCCU. The investigators will not initially collect all potentially relevant fields unique to specific diagnoses. However, future disease-specific studies will allow the addition of data fields in this flexible database environment. This approach will include the tiered acquisition of patient characteristics (age, sex), clinical characteristics, standard-of-care medical treatments and surgical interventions, physiological data (such as vital signs, cerebral blood flow, intracranial pressure, cerebral oximetry etc), laboratory data, and diagnostic studies--particularly neurophysiology, neuropathology, and neuroimaging. Some data elements are inherently less reliable when abstracted from the electronic medical record (e.g., a more detailed social history, establishing premorbid functional status, and independent confirmation of past medical history), and will require an informed consent process to allow the research team to approach subjects or their surrogates.

Similar databases exist at other centers for neurocritical care and have been central to the identification of characteristics, both predictive and associative, of patient outcomes. Done properly, this repository can facilitate many NCCU priorities including hypothesis generating, determining feasibility of single-site trials or involvement in multi-center trials, multimodal monitoring, biomarker research, quality improvement, and resident education.

All data will be collected from the patient medical record, patient bedside monitors, radiology PACS, and laboratory systems. The collection of data will not affect nor delay patient treatment at any instance.

Potential subjects will include patients admitted to University of Maryland's 22-bed NCCU for treatment of a life-threatening neurological illness. All patients 18 years of age and older will be eligible for participation in the study.