Impact of a Specialized Neurointensive Care Team on Outcomes of Critically Ill Acute Ischemic Stroke Patients

Bershad, Eric M.; Feen, Eliahu S.; Hernández, O; Suri, M. Fareed K.; Suárez, José I.

doi:10.1007/s12028-008-9051-5

Cited by 85 publications

(61 citation statements)

References 19 publications

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“…In adults, the neurocritical care literature suggests that patients with both hemorrhagic 23 and ischemic strokes 24 have better outcomes when they are cared for by specialized neurocritical care teams. Neurocritical care fellowship training has emerged to manage adult neurologic emergencies.…”

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confidence: 99%

High critical care usage due to pediatric stroke

Fox

Fullerton

2012

Neurology

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Objectives: To measure intensive care unit (ICU) admission, intubation, decompressive craniotomy, and outcomes at discharge in a large population-based study of children with ischemic and hemorrhagic stroke. Methods:In a retrospective study of all children enrolled in a Northern Californian integrated health care plan (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003), we identified cases of symptomatic childhood stroke (age Ͼ28 days through 19 years) from inpatient and outpatient electronic diagnoses and radiology reports, and confirmed them through chart review. Data regarding stroke evaluation, management, and outcomes at discharge were abstracted. Intensive care unit (ICU) admission, intubation, and decompressive neurosurgery rates were measured, and multivariate logistic regression was used to identify predictors of critical care usage and outcomes at discharge. Results:Of 256 cases (132 hemorrhagic and 124 ischemic), 61% were admitted to the ICU, 32% were intubated, and 11% were treated with a decompressive neurosurgery. Rates were particularly high among children with hemorrhagic stroke (73% admitted to the ICU, 42% intubated, and 19% received a decompressive neurosurgery). Altered mental status at presentation was the most robust predictor for all 3 measures of critical care utilization. Neurologic deficits at discharge were documented in 57%, and were less common after hemorrhagic than ischemic stroke: 48% vs 66% (odds ratio 0.5, 95% confidence interval 0.3-0.8). Case fatality was 4% overall, 7% among children admitted to the ICU, and was similar between ischemic and hemorrhagic stroke.Conclusions: ICU admission is frequent after childhood stroke and appears to be justified by high rates of intubation and surgical decompression. Pediatric stroke occurs in 2-13/100,000 children annually, 1,2 and while hospital case series have reported high rates of neurologic deficits and case fatality, 3,4 data from population-based cohorts are limited. After a large stroke, neurologic deterioration may progress over several days from swelling, intracranial hypertension, and secondary brain injury. Although adult neurocritical care after a stroke has received increasing attention, little has been reported regarding critical care management practices of childhood stroke. However, children may have several reasons to require critical care management of elevated intracranial pressures: 1) children have a high proportion of hemorrhagic strokes, 1,5 2) ischemic strokes in children are predominantly large-vessel, 6,7 and 3) children lack the cerebral atrophy of aging that provides space to accommodate mass effect. We hypothesized that the frequency of ICU admission and interventions such as intubation and surgical decompression would be high after pediatric stroke, even in a

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confidence: 99%

High critical care usage due to pediatric stroke

Fox

Fullerton

2012

Neurology

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“…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].…”

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confidence: 99%

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

2011

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“…Patients in this study who were cared for by an NCC service had a shortened NICU course and hospital stay as well as an improved discharge disposition. Bershad [2008] also reported a reduction in resource utilization and improved patient outcomes for patients with AIS who were treated in a dedicated unit. [18].…”

Section: Fig 3 Total Icu and Hospital Stay Days For Extubated And Tmentioning

confidence: 90%

“…Bershad [2008] also reported a reduction in resource utilization and improved patient outcomes for patients with AIS who were treated in a dedicated unit. [18].…”

Section: Fig 3 Total Icu and Hospital Stay Days For Extubated And Tmentioning

confidence: 90%

Neurological Critical Care Services’ Influence Following Large Hemispheric Infarction and Their Impact on Resource Utilization

Shah

Rincón

et al. 2018

The Journal of Critical Care Medicine

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Impact of a Specialized Neurointensive Care Team on Outcomes of Critically Ill Acute Ischemic Stroke Patients

Abstract: In critically ill acute ischemic stroke patients, institution of a dedicated NCT was associated with a reduction in resource utilization and improved patient outcomes at hospital discharge. Several factors including improved patient care protocols may explain this association.

Cited by 85 publications

References 19 publications

High critical care usage due to pediatric stroke

High critical care usage due to pediatric stroke

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

Neurological Critical Care Services’ Influence Following Large Hemispheric Infarction and Their Impact on Resource Utilization

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