The Role of Neurocritical Care: A Brief Report on the Survey Results of Neurosciences and Critical Care Specialists
Neurocritical care is a new subspecialty field in medicine that intersects with many of the neuroscience and critical care specialties, and continues to evolve in its scope of practice and practitioners. The objective of this study was to assess the perceived need for and roles of neurocritical care intensivists and neurointensive care units among physicians involved with intensive care and the neurosciences.
An online survey of physicians practicing critical care medicine, and neurology was performed during the 2008 Leapfrog initiative to formally recognize neurocritical care training.
The survey closed in July 2009 and achieved a 13% response rate (980/7524 physicians surveyed). Survey respondents (mostly from North America) included 362 (41.4%) neurologists, 164 (18.8%) internists, 104 (11.9%) pediatric intensivists, 82 (9.4%) anesthesiologists, and 162 (18.5%) from other specialties. Over 70% of respondents reported that the availability of neurocritical care units staffed with neurointensivists would improve the quality of care of critically ill neurological/neurosurgical patients. Neurologists were reported as the most appropriate specialty for training in neurointensive care by 53.3%, and 57% of respondents responded positively that neurology residency programs should offer a separate training track for those interested in neurocritical care.
Broad level of support exists among the survey respondents (mostly neurologists and intensivists) for the establishment of neurological critical care units. Since neurology remains the predominant career path from which to draw neurointensivists, there may be a role for more comprehensive neurointensive care training within neurology residencies or an alternative training track for interested residents.
- Mirski MA, Chang CW, Cowan R. Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: evidence-based support for an intensivist-directed specialty ICU model of care. J Neurosurg Anesthesiol. 2001;13:83–92. CrossRef
- Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29(3):635–40. CrossRef
- Webb DJ, Fayad PB, Wilbur C, et al. Effects of a specialized team on stroke care: the first two years of the Yale Stroke Program. Stroke. 1998;26:1353–7. CrossRef
- Wentworth DA, Atkinson RP. Implementation of an acute stroke program decreases hospitalization costs and length of stay. Stroke. 1998;27:1040–3. CrossRef
- Suarez JI, Zaidat OO, Suri MF, et al. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med. 2004;32(11):2311–7.
- Varelas PN, Conti MM, Spanaki MV, et al. The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit. Crit Care Med. 2004;32(11):2191–8.
- Varelas PN, Spanaki MV, Hacein-Bey L. Documentation in medical records improves after a neurointensivist’s appointment. Neurocritical Care. 2005;3(3):234–6. CrossRef
- Varelas PN, Eastwood D, Yun HJ, et al. Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit. J Neurosurg. 2006;104(5):713–9. CrossRef
- Nathens AB, Rivara FP, MacKenzie EJ, Maier RV, Wang J, Egleston B, et al. The impact of an intensivist-model ICU on trauma-related mortality. Ann Surg. 2006;244:545–54.
- Duane TM, Rao IR, Aboutanos MB, Wolfe LG, Malhotra AK. Are trauma patients better off in a trauma ICU? J Emerg Trauma Shock. 2008;1(2):74–7. CrossRef
- Mayer SA. Neurological intensive care: emergence of new specialty. Neurocritical Care. 2006;5(2):82–4. CrossRef
- Mayer SA. UCNS update: setting new standards for neurocritical care training and certification. Currents. 2006;1(2):1–3.
- Wijdicks EFM. Neurocritical care: it’s what we do and what we do best. Neurocritical Care. 2006;5(2):81. CrossRef
- Gobel AJ, Sloman G, Robinson JS. Mortality reduction in a coronary care unit. Br Med J. 1966;1:1005. CrossRef
- Lott JP, Iwashyna TJ, Christie JD, Asch DA, Kramer AA, Kahn JM. Critical illness outcomes in specialty versus general intensive care units. Am J Respir Crit Care Med. 2009;179(8):676–83. CrossRef
- Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151–62. CrossRef
- Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med. 2008;148(11):801–9.
- Leapfrog Group. 2011. http://www.leapfroggroup.org/media/file/WhatsNewin2008Survey.pdf. Accessed 1 Mar 2011.
- Krell KE. Critical care workforce. Crit Care Med. 2008;36(4):1350–3. CrossRef
- Critical care medicine: joint statement of the American Board of Internal Medicine and the American Board of Emergency Medicine. 2011. http://www.abem.org/PUBLIC/_Rainbow/Documents/Joint%20Statement%20for%20Web%2011-24-10%20EDITED-ABIM.pdf. Accessed 1 Mar 2011.
- Nurses’ Health Study. The nurses’ health study: history. 2011. http://www.channing.harvard.edu/nhs/index.php/history/ Accessed 1 Mar 2011.
- Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler CA. Interns’ compliance with accreditation council for graduate medical education work-hour limits. JAMA. 2006;296(9):1063–70. CrossRef
- The Role of Neurocritical Care: A Brief Report on the Survey Results of Neurosciences and Critical Care Specialists
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- Author Affiliations
- 1. Divison of Neurosciences Critical Care, Department(s) of Neurology, Neurosurgery and Anesthesia/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- 2. Neurological Intensive Care Unit, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue/S80, Cleveland, OH, 44195, USA
- 3. R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- 5. Department of Neurosurgery, Strong Memorial Hospital, University of Rochester, Rochester, NY, USA
- 6. Department of Neurology, Queen’s Medical Center, Honolulu, Hawaii
- 4. Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA