The effect of secular trends and specialist neurocritical care on mortality for patients with intracerebral haemorrhage, myasthenia gravis and Guillain–Barré syndrome admitted to critical care

Damian, Maxwell S.; Ben-Shlomo, Yoav; Howard, Robin S.; Bellotti, Tony; Harrison, David A; Griggs, Kathryn; Rowan, Kathy

doi:10.1007/s00134-013-2960-6

Cited by 65 publications

(40 citation statements)

References 30 publications

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“…Continuous and numerous efforts have been made for PPH patients, and the developments in neurological critical care have undoubtedly improved outcomes. 21,22 However, insufficient evidences could be found to prove the superiority of surgery over conservative treatment, making accurate outcome prediction a critical issue for conveying precise information to the families and establishing a reasonable therapeutic approach. In the present study, we developed and validated a simple grading scale, the new PPH score, for 30-day mortality and 90-day functional outcome …”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Grading Scale for Primary Pontine Hemorrhage

Huang

Zhong

Sun

et al. 2017

Stroke

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P rimary pontine hemorrhage (PPH) is the most devastating type of intracranial hemorrhage (ICH), with an acute mortality ranging from 30% to 60%. [1][2][3] Various factors including coma at admission, location, and volume of the hematoma were found to associate with these diverse outcomes. However, inconsistent predictors were reported when different parameters and populations were brought into analysis. [4][5][6][7] As a corollary, it would make cogent sense by combining significant factors into a grading scale to enhance predictive power and, meanwhile, provide a useful tool for physicians in decision-making when facing such patients. 8 Currently, there is no standard, widely accepted early prognostic model or clinical grading scale for outcome prediction in PPH patients. The ICH score, composed of age, Glasgow Coma Scale (GCS), infratentorial origin, intraventricular hemorrhage, and hemorrhage volume, has been widely validated in predicting acute mortality, as well as long-term functional outcome in spontaneous ICH.9,10 Easy to use though, the ICH score and its derivatives tended to deem infratentorial hemorrhage as an independent predictor of poor outcome. 11,12 Because of the small structure of the pons but severe manifestations caused by hemorrhagic impairment, the cutoff value Background and Purpose-We aimed to develop and validate a grading scale for predicting 30-day mortality and 90-day functional outcome in patients with primary pontine hemorrhage (PPH). Methods-We retrospectively reviewed records of consecutive patients with first-ever pontine hemorrhage from 3 teaching hospitals between 2005 and 2012. Independent factors associated with 30-day mortality were identified by logistic regression to establish a risk stratification scale, named the new PPH score. For validation of the new PPH score, we prospectively recruited subjects from 10 units between December 2014 and November 2015. The performance of the new PPH score was presented as discrimination and calibration, measured by area under the curve of the receiver operating characteristic and Hosmer-Lemeshow goodness-of-fit, respectively. Results-Data of 171 patients were available for scale development. The new PPH score consisted of 2 independent factors with individual points assigned as follows: Glasgow Coma Scale score 3 to 4 (=2 points), 5 to 7 (=1 point), and 8 to 15 (=0 point); PPH volume >10 mL (=2 points), 5 to 10 mL (=1 point), and <5 mL (=0 point). An independent cohort of 98 patients was applied as an external validation of the new PPH score. Results showed that the new PPH score was discriminative in predicting both 30-day mortality (area under the curve, 0.902) and 90-day good outcome (area under the curve, 0.927). Furthermore, the new PPH score revealed a good calibration (χ 2 =1.387; P=0.846) in 30-day mortality prediction. Conclusions-The

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Section: Discussionmentioning

confidence: 99%

Development and Validation of a Grading Scale for Primary Pontine Hemorrhage

Huang

Zhong

Sun

et al. 2017

Stroke

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“…Eine aktuelle Querschnittsstudie an über 30.000 SABPatienten zeigte, dass die Behandlung an einem "High-volume"-Zentrum (>100 Patienten/Jahr) mit einer reduzierten [16]. Eine aktuelle multizentrische Arbeit, welche über 80 % der verfügbaren Intensivstationen in England und Wales verglichen hat, untersuchte die Mortalität in Abhängigkeit der behandelnden Intensivstation anhand der Diagnosen -ICB, Myasthenia gravis und Guillain-Barre-Syndrom -an über 10.000 Patienten [5]. Für alle drei Erkrankungen konnte eine signifikant reduzierte Krankenhaussterblichkeit bei NIM-behandelten Patienten aufgezeigt werden.…”

Section: Wahrnehmung Und Einfluss Der Spezialisierten Nimunclassified

“…Für alle drei Erkrankungen konnte eine signifikant reduzierte Krankenhaussterblichkeit bei NIM-behandelten Patienten aufgezeigt werden. Innerhalb der adjustierten multivariatenAnalysezeigtesicheineerhöhte Mortalität für allgemeine Intensivstationen mit kontinuierlicher neurologischer Mitbetreuung und die höchste ohne neurologische Mitbetreuung [5].…”

Section: Wahrnehmung Und Einfluss Der Spezialisierten Nimunclassified

Spezialisierte neurologische neurochirurgische Intensivmedizin

2016

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In Germany dedicated neurological-neurosurgical critical care (NCC) is the fastest growing specialty and one of the five big disciplines integrated within the German critical care society (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin; DIVI). High-quality investigations based on resilient evidence have underlined the need for technical advances, timely optimization of therapeutic procedures, and multidisciplinary team-work to treat those critically ill patients. This evolution has repeatedly raised questions, whether NCC-units should be run independently or better be incorporated within multidisciplinary critical care units, whether treatment variations exist that impact clinical outcome, and whether nowadays NCC-units can operate cost-efficiently? Stroke is the most frequent disease entity treated on NCC-units, one of the most common causes of death in Germany leading to a great socio-economic burden due to long-term disabled patients. The main aim of NCC employs surveillance of structural and functional integrity of the central nervous system as well as the avoidance of secondary brain damage. However, clinical evaluation of these severely injured commonly sedated and mechanically ventilated patients is challenging and highlights the importance of neuromonitoring to detect secondary damaging mechanisms. This multimodal strategy not only requires medical expertise but also enforces the need for specialized teams consisting of qualified nurses, technical assistants and medical therapists. The present article reviews most recent data and tries to answer the aforementioned questions.

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“…3,14 This is likely due to advancements in stroke unit and neurocritical care management of these patients. 18 …”

Section: Risks Of Treatment and The Risk Of No Treatmentmentioning

confidence: 99%