The Appointment of Neurointensivists Is Financially Beneficial to the Employer

Varelas, Panayiotis N.; Abdelhak, Tamer; Wellwood, Jody; Benczarski, Donald; Elias, Stanton B.; Rosenblum, Mark L.

doi:10.1007/s12028-010-9371-0

Cited by 13 publications

(7 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If heterogeneity was detected, meta-regression was performed to explore underlying factors. 14 The presence of publication bias was evaluated using the Begg-Mazumdar rank correlation test. Statistical analyses were performed using Stata (version 14.0, College Station, TX).…”

Section: Methodsmentioning

confidence: 99%

Restarting Anticoagulant Therapy After Intracranial Hemorrhage

Murthy

Gupta

Merkler

et al. 2017

Stroke

175

133

View full text Add to dashboard Cite

Background and Purpose The safety and efficacy of restarting anticoagulation (AC) therapy after intracranial hemorrhage (ICH) remain unclear. We performed a systematic review and meta-analysis to summarize the associations of AC resumption with the subsequent risk of ICH recurrence and thromboembolism. Method We searched published medical literature to identify cohort studies involving adults with anticoagulation-associated ICH. Our predictor variable was resumption of AC. Outcome measures were thromboembolic events (stroke and/or myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects models to assess the strength of association between AC resumption and our outcomes. Results Eight studies were eligible for inclusion in the meta-analysis, with 5,306 ICH patients. Almost all studies evaluated AC with vitamin-K antagonists. Reinitiation of AC was associated with a significantly lower risk of thromboembolic complications (pooled relative risk, 0.34; 95% confidence interval, [CI], 0.25-0.45; Q = 5.12, P for heterogeneity = 0.28). There was no evidence of increased risk of recurrent ICH after reinstatement of AC therapy, although there was significant heterogeneity among included studies (pooled relative risk, 1.01; 95% CI, 0.58-1.77; Q = 24.68, P for heterogeneity <0.001). No significant publication bias was detected in our analyses. Conclusions In observational studies, reinstitution of AC after ICH was associated with a lower risk of thromboembolic complications and a similar risk of ICH recurrence. Randomized clinical trials are needed to determine the true risk-benefit profile of AC resumption after ICH.

show abstract

Section: Methodsmentioning

confidence: 99%

Restarting Anticoagulant Therapy After Intracranial Hemorrhage

Murthy

Gupta

Merkler

et al. 2017

Stroke

175

133

View full text Add to dashboard Cite

show abstract

“…A dedicated NCCU might also be associated with more appropriate resource utilization [ 14 ], better adherence to protocols [ 16 ], better chart documentation [ 11 ], and readmission rates [ 17 ]. If so then objective data are important as it could provide justification and leverage for institutions eager to start their own NCCU [ 18 ]. Thus far, the vast majority of the NCCU studies have come from North America and Europe, whereas there are scarce data from other nations.…”

Section: Introductionmentioning

confidence: 99%

Improved Outcomes following the Establishment of a Neurocritical Care Unit in Saudi Arabia

Soliman

Aletreby

Faqihi

et al. 2018

Critical Care Research and Practice

View full text Add to dashboard Cite

Background Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods A retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group one met criteria for NCCU admission but were admitted to the general ICU as the NCCU was not yet operational (group 1). Group two were subsequently admitted thereafter to the NCCU once it had opened (group 2). The primary outcome was all-cause ICU and hospital mortality. Secondary outcomes were ICU length of stay (LOS), predictors of ICU and hospital discharge, ICU discharge Glasgow Coma Scale (GCS), frequency of tracheostomies, ICP monitoring, and operative interventions. Results Admission to NCCU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; p=0.005). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p < 0.05). Group 2 patients had higher discharge GCS and underwent fewer tracheostomies but more interventional procedures (all p < 0.05). Conclusion Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge.

show abstract

“…Interestingly, the degree of heterogeneity in results was considerably less (I 2 9 and 51%, respectively). Additional benefits ascribed to neurointensivist-led teams have been reported; these include reductions in length of stay [6,9,10,[13][14][15][16], cost savings [6,19], less need for ventriculoperitoneal shunts in SAH patients [13], improved documentation [20] and increased organ and tissue donation rates [21]. Delays in transfer of patients from the emergency department to the neurocritical care unit have also been associated with worse outcomes [22].…”

mentioning

confidence: 99%