A Dedicated Neurological Intensive Care Unit Offers Improved Outcomes for Patients With Brain and Spine Injuries

Abstract

Our findings suggest that admission to a dedicated NeuroICU significantly improves the neurological outcomes of patients with brain and spine injuries, including their postoperative care, in Korea.

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

“…with fewer complications. 1,2,5,6,8,17,18 In line with this, care with dedicated neurointensivists was associated with better outcome compared to historical controls previous literature using a single-center registry in Korea. Therefore, it is not clear whether the difference was simply due to the differences in the level of care over time, management protocols, or the role of neurointensivists in the NICU.…”

“…By contrast, three institutions with dedicated neurointensivisits already had stroke units for stroke patients, and the patients who need real ICU care were admitted to the NICU. Therefore, the baseline characteristics of the patients admitted to the ICU (using only AJ code) (n = 7,410) were not comparable, and more severe patients are in the NICU at the institutions with dedicated neurointensivists (initial NIHSS 14 IQR [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in centers with neurointensivists [n = 473, 6.4%] vs. 6 IQR [2][3][4][5][6][7][8][9][10][11][12][13] in centers without neurointensivists [n = 6,937, 93.6%]) (Supplementary Table 1). Given that respiratory failure is the most common, but important complication in patients with NICU, we selected 1,045 patients with the support of mechanical ventilator among acute ischemic stroke (with neurointensivists group, n = 303 [64.1%, 303 out of 473] and without neurointensitivsts group, n = 1,102 [15.9%, 1,102 out of 6,937]), and then the baseline characteristics were comparable between the two groups ( Table 1).…”

“…In Korea, only 20%-30% of the ICUs have specialized neurointensivists. 6,10,11,25 The lower number of neurointensivists and neurocritical care teams in Korea is particularly alarming because many of the neurocritically ill ischemic stroke patients receive a lower level of critical care, and this may adversely affect their outcomes. A neurocritical care team with a specialized neurointensivist is required for the best organized management of patients with severe ischemic stroke.…”

“…[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.…”

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.…”