Abstract
IntroductionThere are only limited data on the long-term outcome of patients receiving specialized neurocritical care. In this study we analyzed survival, long-term mortality and functional outcome after neurocritical care and determined predictors for good functional outcome.MethodsWe retrospectively investigated 796 consecutive patients admitted to a non-surgical neurologic intensive care unit over a period of two years (2006 and 2007). Demographic and clinical parameters were analyzed. Depending on the diagnosis, we grouped patients according to their diseases (cerebral ischemia, intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), meningitis/encephalitis, epilepsy, Guillain-Barré syndrome (GBS) and myasthenia gravis (MG), neurodegenerative diseases and encephalopathy, cerebral neoplasm and intoxication). Clinical parameters, mortality and functional outcome of all treated patients were analyzed. Functional outcome (using the modified Rankin Scale, mRS) one year after discharge was assessed by a mailed questionnaire or telephone interview. Outcome was dichotomized into good (mRS ≤ 2) and poor (mRS ≥ 3). Logistic regression analyses were calculated to determine independent predictors for good functional outcome.ResultsOverall in-hospital mortality amounted to 22.5% of all patients, and a good long-term functional outcome was achieved in 28.4%. The parameters age, length of ventilation (LOV), admission diagnosis of ICH, GBS/MG, and inoperable cerebral neoplasm as well as Therapeutic Intervention Scoring System (TISS)-28 on Day 1 were independently associated with functional outcome after one year.ConclusionsThis investigation revealed that age, LOV and TISS-28 on Day 1 were strongly predictive for the outcome. The diagnoses of hemorrhagic stroke and cerebral neoplasm leading to neurocritical care predispose for functional dependence or death, whereas patients with GBS and MG are more likely to recover after neurocritical care.
Highlights
There are only limited data on the long-term outcome of patients receiving specialized neurocritical care
The analysis according to admission diagnoses revealed that nearly 60% of all patients suffered from stroke
Patients were diagnosed with subarachnoid hemorrhage (SAH) in 5% (n = 38), epileptic seizures in 12% (n = 93), meningoencephalitis in 6% (n = 49), Guillain-BarréSyndrome and myasthenia gravis in 3% (n = 25), neurodegenerative diseases and encephalopathy in 3% (n = 22), cerebral neoplasm in 3% (n = 22), and intoxications in 3% (n = 27)
Summary
There are only limited data on the long-term outcome of patients receiving specialized neurocritical care. In this study we analyzed survival, long-term mortality and functional outcome after neurocritical care and determined predictors for good functional outcome. Within the last decades, specialized neurocritical intensive care units (NICU) have evolved from bigger, multidisciplinary ICUs [1]. This specialization has led to a decrease in both in-hospital mortality and length of hospital stay without associated effects on readmission rates and long-term mortality [2]. There are still little data on clinical parameters associated with long-term outcome after neurocritical care; aside from age, the major. In order to provide data that facilitate the assessment of long-term prognosis after neurocritical care we aimed to identify predisposing factors for a good functional recovery one year after treatment on a specialized neurocritical care unit
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