Improved Outcomes following the Establishment of a Neurocritical Care Unit in Saudi Arabia

Abstract

Background Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods A retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group one met criteria for NCCU admission but were admitted to the general ICU as the NCCU was not yet operational (group 1). Group two were subsequently admitted thereafter to the NCCU once it had opened (group 2). The primary outcome was all-cause ICU and hospital mortality. Secondary outcomes were ICU length of stay (LOS), predictors of ICU and hospital discharge, ICU discharge Glasgow Coma Scale (GCS), frequency of tracheostomies, ICP monitoring, and operative interventions. Results Admission to NCCU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; p=0.005). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p < 0.05). Group 2 patients had higher discharge GCS and underwent fewer tracheostomies but more interventional procedures (all p < 0.05). Conclusion Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge.

Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea

“…Neurocritical care is a subspecialty of critical care medicine that provides optimal and specialized care to neurocritically ill patients. [1][2][3] Those patients require special, integrated care on the neurological as well as systemic problems as a part of critical care in the neurological intensive care unit (NICU). [1][2][3][4] Several studies show that the existence of neurointensivists and NICU had a significant favorable effect on the outcome of critically ill patients with brain injuries, including stroke.…”

“…[1][2][3] Those patients require special, integrated care on the neurological as well as systemic problems as a part of critical care in the neurological intensive care unit (NICU). [1][2][3][4] Several studies show that the existence of neurointensivists and NICU had a significant favorable effect on the outcome of critically ill patients with brain injuries, including stroke. 1,[5][6][7][8][9] In Korea, specialized critical care teams are relatively lacking compared to other countries.…”

“…[1][2][3][4] Several studies show that the existence of neurointensivists and NICU had a significant favorable effect on the outcome of critically ill patients with brain injuries, including stroke. 1,[5][6][7][8][9] In Korea, specialized critical care teams are relatively lacking compared to other countries. 10 Although, the beneficial effect of neurocritical care on patients in NICU have been reported in the literature, 6,11 those reports were mainly from single-center experience.…”

SHORT TERM ICU MORTALITY AND PATIENTS’S CHARACTERISTICS: A RETROSPECTIVE STUDY IN a COLLEGE HOSPITAL

“…In Saudi Arabia, there are different reports about the mortality rate with a huge controversy over the underlying causes and predictors. [7][8][9] Therefore, the aim of the study was to evaluate the characteristics of ICU patients and their short-term mortality. mortality.…”

A Perspective from the Neurocritical Care Society and the Society of Critical Care Medicine: Team-Based Care for Neurological Critical Illness

“…Additionally, there are robust retrospective data showing similar benefit from deploying an NCC service in an institution previously without a subspecialty-led NCC team for the care of patients with ICH, ischemic stroke, traumatic brain injury (TBI), and subarachnoid hemorrhage [6][7][8][9][10][11][12][13][14][15]. The most recent data demonstrate benefit both in the USA and internationally [16][17][18][19][20]. The Standards manuscript, similar to the constructs in the ACS Committee on Trauma's Resources for the Optimal Care of the Injured Patient, bases its criteria largely on ICU structure and staffing in the USA, which may embrace a different structure and be underpinned by different resources.…”