Bedside clinical neurologic assessment utilisation in paediatric cardiac intensive care units

Abstract

IntroductionNeurodevelopmental disabilities in children with CHD can result from neurologic injury sustained in the cardiac ICU when children are at high risk of acute neurologic injury. Physicians typically order and specify frequency for serial bedside nursing clinical neurologic assessments to evaluate patients’ neurologic status.Materials and methodsWe surveyed cardiac ICU physicians to understand how these assessments are performed, and the attitudes of physicians on the utility of these assessments. The survey contained questions regarding assessment elements, assessment frequency, communication of neurologic status changes, and optimisation of assessments.ResultsSurveys were received from 50 institutions, with a response rate of 86%. Routine clinical neurologic assessments were reported to be performed in 94% of institutions and standardised in 56%. Pupillary reflex was the most commonly reported assessment. In all, 77% of institutions used a coma scale, with Glasgow Coma Scale being most common. For patients with acute brain injury, 82% of institutions reported performing assessments hourly, whereas assessment frequency was more variable for low-risk and high-risk patients without overt brain injury. In all, 84% of respondents thought their current practice for assessing and monitoring neurologic status was suboptimal. Only 41% felt that the Glasgow Coma Scale was a valuable tool for assessing neurologic function in the cardiac ICU, and 91% felt that a standardised approach to assessing pre-illness neurologic function would be valuable.ConclusionsRoutine nursing neurologic assessments are conducted in most surveyed paediatric cardiac ICUs, although assessment characteristics vary greatly between institutions. Most clinicians rated current neurologic assessment practices as suboptimal.

Improving “Neuro Checks” in Neonatal ICU and PICU Is a Serial Neurologic Assessment in Pediatrics*

“…Despite its potential limitations, SNAP also has the potential to achieve an ideal balance between the complexity of a complete neurologic examination and user friendliness for critical care nurses and practitioners to detect neurologic events. For this reason, SNAP may be seen as an alternate “neuro check” to the GCS, which is currently most commonly used in the PICU setting (12). SNAP checks can be performed at admission, recorded over time, and communicated among critical care nurses and practitioners in a clear and concise manner.…”