The Impact of a Neuro-Intensivist on Patients with Stroke Admitted to a Neurosciences Intensive Care Unit
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ORIGINAL PAPER
The Impact of a Neuro-Intensivist on Patients with Stroke Admitted to a Neurosciences Intensive Care Unit Panayiotis N. Varelas Æ Lonni Schultz Æ Mary Conti Æ Marianna Spanaki Æ Thomas Genarrelli Æ Lotfi Hacein-Bey
Published online: 15 January 2008 Ó Humana Press Inc. 2008
Abstract Introduction Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU). Methods Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate analyses. Results One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the
P. N. Varelas (&) M. Spanaki Department of Neurology, Henry Ford Hospital, K-11, 2799 West Grand Blvd, Detroit, MI 48202, USA e-mail: [email protected] P. N. Varelas Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA L. Schultz Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI, USA M. Conti T. Genarrelli Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA L. Hacein-Bey Departments of Radiology, Neurology and Neurosurgery, Loyola University, Chicago, IL, USA
period after the NI. Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs. 54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period (Cox proportional hazard ratios, 95% CI were 2.37, 1.4–4.1 and 1.8, 1.04–3 for IS, 1.98, 1.3–3 and 1.2, 0.8–1.9 for ICH, and 1.6, 1.1–2.3 and 1.4, 1.01–2 for SAH, respectively) or for all strokes (1.92, 1.52–2.43 and 1.7, 1.28–2.25 for the first 12 days of hospital admission). Conclusion The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU. Keywords Ischemic stroke Intracerebral hemorrhage Subarachnoid hemorrhage Neurosciences Intensive Care Unit Neurointensivist
Introduction Stroke units reduce mortality, dependency, and hospital length of stay (LOS) in patients with acute stroke [1, 2]. The term stroke unit denotes a geographically defined hospital facility lacking invasive monitoring and artificial ventilation capabilities and is usually reserved for mild or moderate severity strokes [3]. Patients with more severe strokes may require more intensive management in a general Intensive Care Unit (ICU) or a specialized Neurological/Neurosurgical Intensive Care Unit (NICU)
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