Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit.
Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit.
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DOI：
10.3346/jkms.2017.32.6.1024
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发表时间：
2017-06
影响因子：
4.5
通讯作者：
Hong SC
中科院分区：
文献类型：
--
作者：
Ryu JA;Yang JH;Chung CR;Suh GY;Hong SC
关于韩国神经外科重症监护病房 (NSICU) 开始神经重症监护室共同管理后结局改善的数据有限。我们评估了新任命的神经重症监护医生对入住重症监护病房 (ICU) 的神经外科患者的结果的影响。这项回顾性观察研究涉及 2013 年 3 月至 2016 年 5 月期间入住三星医疗中心 NSICU 的神经外科患者。神经重症监护医师共同管理于 2014 年 10 月 1 日开始。我们比较了神经外科患者在神经重症监护医师共同管理之前和之后的结果。主要结局是 ICU 死亡率。研究期间共有 571 名患者入住 NSICU，其中 291 名患者在开始神经重症监护室共同管理之前，280 名患者开始神经重症监护后。颅内出血（29.6%）和创伤性脑损伤（TBI）（26.6%）是入住 ICU 的最常见原因。 TBI 是最常见的死亡原因 (39.0%)。共同管理前后死亡率和 ICU 住院时间无显着差异。然而，与开始神经重症监护联合治疗前相比，TBI 患者的 ICU 发生率和 30 天死亡率显着降低（分别为 8.5% vs. 22.9%；P = 0.014 和 11.0% vs. 27.1%；P = 0.010）。尽管神经重症医师共同管理后的总体结果没有差异，但神经重症医师常规参与策略的启动显着降低了 TBI 患者的 ICU 死亡率和 30 天死亡率。
Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients.