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

Ibrahim Soliman,Fahad Faqihi,Nasir Nasim Mahmood,Babar Kahlon,Waleed Tharwat Aletreby,Omar E Ramadan,Abdulrahman Alharthy,Peter Brindley,Ahmad Fouad Mady,Dimitrios Karakitsos

doi:10.1155/2018/2764907

Abstract

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.

Highlights

Neurocritical care (NCC) is an expanding subspecialty within critical care medicine while NCC board certification has been offered since 2007 [1, 2]
Group 1 included all neurologically injured patients admitted to the general intensive care unit (ICU) but who fulfilled neurocritical care unit (NCCU) admission criteria. ese NCCU admission criteria, served as the study’s inclusion criteria, were as follows: (1) Need for intracranial pressure (ICP) monitoring
Since no NCCU yet existed, they were admitted in the polyvalent ICU and represented Group 1 in our study

Summary

Background

Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. E 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. 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 had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p < 0.05). Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge

Introduction

Statistical Analysis

Results

Discussion

Conclusion