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How does care differ for neurological patients admitted to a neuro-ICU versus a general ICU? The Greater New York Hospital Association ICU Prevalence Survey
Critical Care volume 12, Article number: P497 (2008)
Outcomes research suggests that neurological patients cared for in specialized neuro-ICUs have lower mortality and better outcomes compared with general ICUs. However, little is known about how the process of care differs in these two types of units.
The Greater New York Hospital Association conducted a city-wide 24-hour ICU prevalence survey on 15 March 2007. Data were collected on all patients admitted to 141 ICUs in 68 different hospitals.
Of 1,906 ICU patients surveyed, 231 with a primary neurological diagnosis were analyzed; 52 (22%) were admitted to a neuro-ICU and 179 (78%) to a general ICU. 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 slightly lower rate of mechanical ventilation (39% vs 50%, P = 0.15), the ICU length of stay (LOS ≥ 10 days) was longer in neuro-ICUs (40% vs 17%, P < 0.0001). Neuro-ICU patients had more often undergone tracheostomy (35% vs 15%, P = 0.043), invasive hemodynamic monitoring (40% vs 20%, P = 0.002), and external ventricular drain placement (14% vs 1%, P < 0.001) than patients cared for in general ICUs; the use of intracranial pressure bolts (15% vs 9%, P = 0.18) and electroencephalogram monitoring was similar (4% vs 6%, P = 1.00). There was no difference in the use of intravenous insulin (4% vs 9%, P = 0.37) or analgesics (14% vs 12%, P = 0.82), but intravenous sedation was less prevalent in neuro-ICUs (12% vs 30%, P = 0.009). Fewer neuro-ICU patients had received blood transfusions (0% vs 8%, P = 0.03) and more were receiving nutritional support compared with general ICUs (67% vs 39%, P < 0.001). The frequency of Do-Not-Resuscitate orders was also somewhat lower in neuro-ICUs (3.8% vs 8.4%, P = 0.37).
Neurological patients cared for in specialty neuro-ICUs had longer ICU LOS, underwent more invasive intracranial and hemodynamic monitoring, tracheostomy, and nutritional support, and received less intravenous sedation than patients in general ICUs. These differences in care may explain previously observed disparities in outcome between neuro-ICUs and general-ICUs.
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Kurtz, P., Fitts, V., Sumer, Z. et al. How does care differ for neurological patients admitted to a neuro-ICU versus a general ICU? The Greater New York Hospital Association ICU Prevalence Survey. Crit Care 12, P497 (2008). https://doi.org/10.1186/cc6718
- Traumatic Brain Injury
- Intravenous Sedation
- Nutritional Support
- External Ventricular Drain
- Hemodynamic Monitoring