Satoshi Egawa1, Toru Hifumi2, Kenya Kawakita3, Masanobu Okauchi4, Atsushi Shindo5, Masahiko Kawanishi6, Takashi Tamiya7, Yasuhiro Kuroda8. 1. Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: s.egawa7701@gmail.com. 2. Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: hifumitoru@gmail.com. 3. Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: kenfact@kms.ac.jp. 4. Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: okauchi@med.kagawa-u.ac.jp. 5. Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: ashindo@kms.ac.jp. 6. Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: mk@kms.ac.jp. 7. Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: tamiya@kms.ac.jp. 8. Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: kuroday@kms.ac.jp.
Abstract
PURPOSE: The purpose of the study is to evaluate the impact of neurointensivist-managed intensive care unit (NIM-ICU) implementation for patients admitted with aneurysmal subarachnoid hemorrhage (SAH). METHODS: This study retrospectively evaluated 234 patients (mean age, 61.7 years; male, 67) admitted with SAH between January 1, 2001, and March 31, 2014. Neurologic outcomes between patients admitted from January 2001 to December 2006 (intensivist-managed intensive care unit group) and January 2007 to March 2014 (NIM-ICU group) were compared. The primary outcome was the incidence of a good neurologic outcome at discharge (GO; the modified Ranking Scale score: GO, 0-2; poor neurological outcome, 3-6) at discharge. RESULTS: Neurointensivist-managed intensive care unit was initiated for 151 (64.5%) of 234 patients. Univariate analysis demonstrated significantly better outcomes for NIM-ICU group vs intensivist-managed intensive care unit group (GOs, 58.3% vs 41.0%, respectively, P = .01). Multivariate logistic regression was used to evaluate NIM-ICU efficacy for SAH patients, but NIM-ICU was not significantly associated with GOs (P = .054). Subgroup analysis of patient grading by Hunt and Kosnik grades I to II showed that NIM-ICU implementation was an independent predictor of GOs (odds ratio, 4.54; 95% confidence interval, 1.08-22.17; P = .04). CONCLUSION: Neurointensivist-managed intensive care unit may improve neurologic outcomes in SAH patients with Hunt and Kosnik grades I to II.
PURPOSE: The purpose of the study is to evaluate the impact of neurointensivist-managed intensive care unit (NIM-ICU) implementation for patients admitted with aneurysmal subarachnoid hemorrhage (SAH). METHODS: This study retrospectively evaluated 234 patients (mean age, 61.7 years; male, 67) admitted with SAH between January 1, 2001, and March 31, 2014. Neurologic outcomes between patients admitted from January 2001 to December 2006 (intensivist-managed intensive care unit group) and January 2007 to March 2014 (NIM-ICU group) were compared. The primary outcome was the incidence of a good neurologic outcome at discharge (GO; the modified Ranking Scale score: GO, 0-2; poor neurological outcome, 3-6) at discharge. RESULTS: Neurointensivist-managed intensive care unit was initiated for 151 (64.5%) of 234 patients. Univariate analysis demonstrated significantly better outcomes for NIM-ICU group vs intensivist-managed intensive care unit group (GOs, 58.3% vs 41.0%, respectively, P = .01). Multivariate logistic regression was used to evaluate NIM-ICU efficacy for SAHpatients, but NIM-ICU was not significantly associated with GOs (P = .054). Subgroup analysis of patient grading by Hunt and Kosnik grades I to II showed that NIM-ICU implementation was an independent predictor of GOs (odds ratio, 4.54; 95% confidence interval, 1.08-22.17; P = .04). CONCLUSION: Neurointensivist-managed intensive care unit may improve neurologic outcomes in SAHpatients with Hunt and Kosnik grades I to II.
Authors: Asma M Moheet; Angela H Shapshak; Megan A Brissie; Yasser B Abulhasan; Gretchen M Brophy; Jennifer Frontera; Wiley R Hall; Sayona John; Atul A Kalanuria; Abhay Kumar; Abhijit V Lele; Shraddha Mainali; Casey C May; Stephan A Mayer; Victoria McCredie; Gisele S Silva; Jeffrey M Singh; Alexis Steinberg; Gene Sung; Eljim P Tesoro; Aleksandra Yakhkind Journal: Neurocrit Care Date: 2020-08 Impact factor: 3.210