The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit*

Varelas, Panayiotis N.; Conti, Mary; Spanaki, Marianna V.; Potts, Eric A; Bradford, Deborah; Sunstrom, Cindy; Fedder, Wende; Bey, Lotfi Hacein; Jaradeh, Safwan; Gennarelli, Thomas A.

doi:10.1097/01.ccm.0000146131.03578.21

Cited by 132 publications

(97 citation statements)

References 32 publications

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“…[25][26][27] Several observational studies have suggested that an organized, protocol-based approach with emphasis on the prevention of ''secondary'' neurological insults may be associated with improved recovery. [28][29][30][31][32][33][34] Consistent with these developments, the care of neurocritical care patients in our region of Canada has evolved considerably over the past decade. There are few contemporary data assessing whether outcomes have changed.…”

Section: Résumémentioning

confidence: 98%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 98%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

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“…Five studies reported detailed outcome information, usually in the form of Glasgow Outcome Scale scores after C6 months [4,7,8,11,14]. Five of the remaining seven studies reported discharge disposition [3,6,9,10,12]; for the purposes of this study we defined discharge home (as opposed to a longterm care or rehabilitation facility) as a favorable outcome.…”

mentioning

confidence: 99%

“…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%

“…Two studies were methodologically stronger, in that they involved multiple centers and compared patients treated in specialized ICUs with concurrent controls cared for in generalized units [5,12]. Most, but not all, studies performed multivariate analysis, adjusting for at least some potentially confounding variables [3,5,9,10,12,14]. The ''intervention'' of interest varied considerably across studies: in most cases, care was provided in a neurologic ICU, with an attending physician who was a neurointensivist [3, 5, 6, 8-11, 13, 14]; however, in two studies (including the largest), neurologic ICUs were compared with general ICUs, regardless of the particular expertise of clinicians [4,12]; in another study, there were simply alterations in the process of care, with implementation of protocols designed to prevent secondary brain injury, but no change in personnel [7].…”

mentioning

confidence: 99%

“…We identified 12 studies, involving 24,520 patients, which presented original data comparing models of care for critically ill neurologic patients [3][4][5][6][7][8][9][10][11][12][13][14]. Four studies assessing subgroups derived from previously published data were excluded (see Electronic Supplementary Material) [15][16][17][18].…”

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confidence: 99%

See 2 more Smart Citations

Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs

Kramer

Zygun

2011

Neurocrit Care

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Neurocritical Care Outcomes, Research, and Technology

2019

Self Cite

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eurocritical care (NCC) is a specialty drawing professionals with background training in neurology, neurosurgery, anesthesiology, internal medicine, and emergency medicine. Since the 1980s, NCC has grown into an organized subspecialty with establishment of neurointensive care units (neuro-ICUs) and professional organizations. The most prominent dedicated society, the Neurocritical Care Society (NCS), founded in 2002, counts more than 2500 members, with neurologists comprising the largest primary specialty (Rakela Miller, NCS, written communication, June 5, 2018). Neurocritical care education varies among different countries. In the United States, neurocritical care subspecialization can be pursued through fellowship training after completion of residency training in neurology, neurosurgery, anesthesiology, internal medicine, or emergency medicine, or as additional training after completing a critical care fellowship program. Fellowships are accredited by 2 organizations: United Council for Neurologic Subspecialties (UCNS) and, for neurosurgeons, Committee on Advanced Subspecialty Training. Currently, there are 68 UCNSaccredited neurocritical care programs and 22 Committee on Advanced Subspecialty Training programs; the numbers are growing. Among 1374 UCNS-certified diplomats in neurocritical care, 576 (41.9%) are board-certified neurologists (Becky Swanson, UCNS, written communication, April 17, 2018). Following efforts to integrate neurocritical care with other subspecialties, neurocritical care has recently been approved as a subspecialty by the American Board of Medical Specialties. It is yet to be seen how this approval will affect organization and education.In other countries, the proportion of neurologists within the pool of neurointensivists varies, but independently, the addition of neurocritical care has opened a new career path to neurologists IMPORTANCE Neurocritical care has grown into an organized specialty that may have consequences for patient care, outcomes, research, and neurointensive care (neuroICU) technology.OBSERVATIONS Neurocritical care improves care and outcomes of the patients who are neurocritically ill, and neuroICUs positively affect the financial state of health care systems. The development of neurocritical care as a recognized subspecialty has fostered multidisciplinary research, neuromonitoring, and neurocritical care information technology, with advances and innovations in practice and progress.CONCLUSIONS AND RELEVANCE Neurocritical care has become an important part of health systems and an established subspecialty of neurology. Understanding its structure, scope of practice, consequences for care, and research are important.

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The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit*

Cited by 132 publications

References 32 publications

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs

Neurocritical Care Outcomes, Research, and Technology

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