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How Does Care Differ for Neurological Patients Admitted to a Neurocritical Care Unit Versus a General ICU?

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Abstract

Background

Neurological patients have lower mortality and better outcomes when cared for in specialized neurointensive care units than in general ICUs. However, little is known about how the process of care differs between these types of units.

Methods

The Greater New York Hospital Association conducted a city-wide 24-h ICU prevalence survey on March 15th, 2007. Data was collected on all patients admitted to 143 ICUs in 69 different hospitals.

Results

Of 1,906 ICU patients surveyed, 231 had a primary neurological diagnosis. Of these, 52 (22%) were admitted to one of 9 neuro-ICU’s in NY and 179 (78%) to a medical or surgical ICU. Neurological patients in neuro-ICUs were more likely to have been transferred from an outside hospital (37% vs. 11%, P < 0.0001). Hemorrhagic stroke was more frequent in neuro-ICUs (46% vs. 16%, P < 0.0001), whereas traumatic brain injury (2% vs. 24%, P < 0.0001) and ischemic stroke (0% vs. 19%, P = 0.001) were less common. Despite a lower rate of mechanical ventilation (39% vs. 50%, P = 0.15), ICU length of stay was longer in neuro-ICU patients (≥10 days, 40% vs. 17%, P < 0.0001). More neuro-ICU patients had undergone tracheostomy (35% vs. 15%, P = 0.04), invasive hemodynamic monitoring (40% vs. 20%, P = 0.002), and invasive intracranial pressure monitoring (29% vs. 9%, P < 0.001) than patients cared for in general ICUs. Intravenous sedation was less prevalent in neuro-ICUs (12% vs. 30%, P = 0.009) and more patients were receiving nutritional support compared to general ICUs (67% vs. 39%, P < 0.001).

Conclusions

Neurological patients cared for in specialty neuro-ICUs underwent more invasive intracranial and hemodynamic monitoring, tracheostomy, and nutritional support, and received less IV sedation than patients in general ICUs. These differences in care may explain previously observed disparities in outcome between neurocritical care and general ICUs.

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Acknowledgments

The authors wish to thank the many physicians and nurses who participated in the Greater New York Hospital Association/United Hospital Fund ICU Survey. GNYHA, a trade association representing 150 hospitals throughout New York State, New Jersey, Connecticut, Pennsylvania, and Rhode Island, and UHF, a private not-for-profit health services research and philanthropic organization, formed a partnership in 2005 to support hospitals’ quality improvement efforts. This survey was part of the initiatives they partner on in the area of critical care.

Conflict of interest

The authors have no potential conflicts of interest to report.

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Correspondence to Stephan A. Mayer.

Additional information

This study was conducted on behalf of the GNYHA Critical Care Leadership Committee.

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Kurtz, P., Fitts, V., Sumer, Z. et al. How Does Care Differ for Neurological Patients Admitted to a Neurocritical Care Unit Versus a General ICU?. Neurocrit Care 15, 477–480 (2011). https://doi.org/10.1007/s12028-011-9539-2

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