989

Abstract

Introduction: Limited data suggest that potentially inappropriate medications (PIMs) impact outcomes in critically ill elderly patients. PIMs are medications that may increase cognitive burden. There is no data available on the association between PIM use and clinical outcomes in neurocritical care elderly patients. Hypothesis: The use of PIMs in neurocritical care elderly patients is associated with worse outcomes. Methods: This is a retrospective study of neuroscience ICU(NSICU) patients aged? 65 years admitted between March and July 2011. PIMs were used to calculate a drug burden index(DBI) and pre/post dose sedation recovery time was assessed using RASS. Descriptive statistics and regression analyses were used, as appropriate. Results: There were 112 critically ill elderly NSICU patients included in this study. The median age was 79 years, 51% were male, and median (IQR) APACHE II score was 12(9 – 16). Diagnoses included TBI (n=34), AIS (n =31), ICH (n=14), SAH (n=8),tumor (n=6), SCI (n =6), SE (n =3), and other (n =3). 18.8% of patients received no intermittent (int) PIMs, 28.6% received 1, and 52.7% received? 2; 25% (n = 28) of patients were given? 1 continuous infusion PIM. RASS scores decreased with 56% of intPIM doses (n =28), most frequently with opioids,and all were in TBI patients. Median (IQR) recovery time to a goal RASS score of 0 to -1 was 14 (7– 79) hrs. The DBIs for days 1, 2 and 3 were not associated with worse outcomes. However, the DBI from 72 hours after admit until discharge showed a higher DBI (above the median DBI) was associated with a worse discharge GCS (p=0.01), and in increase in NSICU LOS and hospital LOS by 3.5 days and 4.9 days, respectively (p<0.0001, adjusted for APACHE II score and Charlson Comorbidity Index). There was no significant difference in mortality. Conclusions: Over 80% of critically ill elderly patients with neurological injury received? 1 PIM while in the NSICU. RASS scores decreased with a majority of intPIM doses and median recovery time to a goal RASS was 14 hours. A higher DBI after 72 hours in the NSICU was associated with a significantly worse discharge GCS and a longer NSICU and hospital LOS, even after adjusting for baseline severity of illness.