Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit

Varelas, Panayiotis N.; Eastwood, Dan; Yun, Hyun J.; Spanaki, Marianna V.; Bey, Lotfi Hacein; Kessaris, Christos; Gennarelli, Thomas A.

doi:10.3171/jns.2006.104.5.713

Cited by 129 publications

(89 citation statements)

References 24 publications

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“…Varelas et al reported that a neurointensivist-led team model showed a 4% relative reduction of the in-hospital mortality rate and improved documentation of the GCS score (from 60.4% to 82%) in head injury patients. 4 Mirski et al also found that introducing a team to ICUs that is specifically trained for neuroscience critical care decreased mortality from 36% to 19% and increased the proportion of good outcomes in patients with intracranial hemorrhage from 48% to 69%. 5 Compared with these reports, our patients in both groups had much lower mortality rates (0.96%) and much improved neurological outcomes (complication rates were \ 5%).…”

Section: Discussionmentioning

confidence: 99%

“…2,3 In addition, it has been reported that utilization of a neurointensive care unit team decreased mortality rates, shortened hospital length of stay, and improved patient outcomes in the neurological and neurosurgical populations. 4,5 Collectively, it is conceivable that intensive care has a significant impact on critically ill patient outcomes. However, it has not been determined whether intensive care based on continuous monitoring (electrocardiogram (ECG), blood pressure, and pulse oximetry [SpO 2 ]) and frequent neurologic evaluation by ICU staff has a significant impact on elective neurosurgical patient outcome in those who are in good physical condition.…”

Section: Résumémentioning

confidence: 99%

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The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

Terada

Inoue

Tanaka

et al. 2010

Can J Anesth/J Can Anesth

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The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study L'influence des soins intensifs postopératoires sur le devenir des patients en bonne santé ayant subi une neurochirurgie non urgente: une étude unicentrique par appariement des scores de propension Abstract Purpose In the last three years, all elective neurosurgical cases were performed by a single surgeon at Nara Medical University. For the last year and a half, all patients were transferred to a newly created neurosurgical intensive care unit. The purpose of this study was to evaluate the impact of admission to an intensive care unit after elective neurosurgery. Methods This study was conducted as a retrospective clinical chart review. Institutional ethics approval was waived, and we reviewed the charts of 296 neurosurgical patients who were American Society of Anesthesiologists' physical status I-II. To avoid channelling bias, propensity score analysis was used to generate a set of matched cases (patients transferred to the intensive care unit [ICU]) and controls (patients transferred to the neurosurgical ward). This process resulted in 104 matched pairs of elective surgical patients who did or did not have an ICU admission after surgery. Glasgow outcome scale (GOS) at discharge or at three months after the operation was compared as the primary outcome measure. As secondary outcome measures, we also compared rates of severe early complications and patient satisfaction regarding perioperative patient care.Results With an unmatched population, poor GOS tended to occur more often in the non-ICU group than in the ICU group (6.5% vs 2.3%, respectively). Mortality rates and severe early complication rates also tended to be higher in the non-ICU group than in the ICU group (2.4% and 5.3%, respectively, non-ICU group vs 0.8% and 2.3%, respectively, ICU group). However, after propensity score matching, there was no difference regarding the GOS between groups. Both groups showed very high good outcome percentages (98.1% ICU vs 97.1% non-ICU). With regard to mortality rates and severe early complications, both groups showed low mortality (0.96% vs 0.96%) and complication rates (2.89% ICU vs 3.85% non-ICU). Patient care in the ICU failed to increase patient satisfaction regarding the overall hospital care. Conclusion The results of this analysis suggest that admission to an ICU after elective neurosurgery has little impact on outcomes. RésuméObjectif Au cours des trois dernie`res anne´es, toutes les neurochirurgies non urgentes ont e´te´effectue´es par un seul chirurgien a`la Nara Medical University et, au cours des 18 derniers mois, tous les patients ont e´te´transfe´re´s dans une nouvelle unite´de soins intensifs en neurochirurgie. L'objectif

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Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

Terada

Inoue

Tanaka

et al. 2010

Can J Anesth/J Can Anesth

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“…Interestingly, the degree of heterogeneity in results was considerably less (I 2 9 and 51%, respectively). Additional benefits ascribed to neurointensivist-led teams have been reported; these include reductions in length of stay [6,9,10,[13][14][15][16], cost savings [6,19], less need for ventriculoperitoneal shunts in SAH patients [13], improved documentation [20] and increased organ and tissue donation rates [21]. Delays in transfer of patients from the emergency department to the neurocritical care unit have also been associated with worse outcomes [22].…”

mentioning

confidence: 99%

“…We identified 12 studies, involving 24,520 patients, which presented original data comparing models of care for critically ill neurologic patients [3][4][5][6][7][8][9][10][11][12][13][14]. Four studies assessing subgroups derived from previously published data were excluded (see Electronic Supplementary Material) [15][16][17][18].…”

mentioning

confidence: 99%

Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs

2011

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“…Se procederá al ingreso precoz en UCI 9 . Se controlará estrictamente: temperatura, glucemia, crisis comiciales y sepsis (control metabólico inicial).…”

Section: Medidas Generalesunclassified

Actualizaciones en el manejo del traumatismo craneoencefálico grave

2009

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El traumatismo craneoencefálico (TCE) es una importante causa de morbimortalidad en cualquier lugar del mundo; afecta más a varones jóvenes y genera un problema de salud pública. Desafortunadamente, los avances en los conocimientos fisiopatológicos no han ido seguidos de similar desarrollo en las opciones terapéuticas, y no se dispone en la actualidad de fármacos neuroprotectores contrastados.En este artículo revisamos la epidemiología, la fisiopatología y las medidas terapéuticas utilizadas en el manejo del paciente con TCE grave. Se analizan tanto las medidas generales como las dirigidas al control de la hipertensión intracraneal, el papel de la cirugía y algunas opciones terapéu-ticas más innovadoras actualmente en fase de valoración en estos pacientes. UPDATES OF SEVERE TRAUMATIC BRAIN INJURY MANAGEMENT Traumatic brain injury (TBI)is an important reason of morbidity-mortality all over the world, affecting young males more and generating Public Health problem. Unfortunately, the advances in the pathophysiology knowledge have not followed a similar development in therapeutic options, there currently not being any contrasted neuroprotectants.In this article, we have reviewed the epidemiology, pathophysiology and therapeutic measures used in the management of patient with severe TBI. The general measures as well as those aimed at controlling intracranial hypertension, the role of the surgery and some more innovative therapeutic options currently under evaluation in these patients are analyzed.

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Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit

Abstract: The institution of a neurointensivist-led team model had an independent, positive impact on patient outcomes, including a lower NICU-associated mortality rate and hospital LOS, improved disposition, and better chart documentation.

Cited by 129 publications

References 24 publications

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs

Actualizaciones en el manejo del traumatismo craneoencefálico grave

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