Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Feb;16(1):63-71.
doi: 10.1007/s12028-011-9620-x.

Impact of a neurointensivist on outcomes in critically ill stroke patients

Lisa Knopf  1 , Ilene Staff, Joao Gomes, Louise McCullough
Affiliations

Impact of a neurointensivist on outcomes in critically ill stroke patients

Lisa Knopf et al. Neurocrit Care. 2012 Feb.

Abstract

Background: Current guidelines for management of critically ill stroke patients suggest that treatment in a neurocritical care unit (NCCU) and/or by a neurointensivist (NI) may be beneficial, but the contribution of each to outcome is unknown. The relative impact of a NCCU versus NI on short- and long-term outcomes in patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and aneurysmal subarachnoid hemorrhage (SAH) was assessed.

Methods: 2,096 stroke patients admitted to a NCCU or nonneuro ICU at a tertiary stroke center were analyzed before the appointment of a NI, during the NI's tenure, and after the NI departed and was not replaced. Data included admission ICU type, availability of a NI, age, NIHSS, ICH score, and 3 and 12 month outcome.

Results: For AIS, compared to the time interval with a NI, departure of the NI predicted a worse rate of return to pre-stroke function at 3 months. For ICH, NCCU treatment predicted shorter ICU and hospital LOS but had no effect on short- or long-term outcomes. No effect of a NI was seen. For SAH, availability of an NI (but not an NCCU) predicted improved outcomes but longer ICU LOS. Disposition and in-hospital mortality improved when a NI was present, but continued improvement did not occur after the NI's departure.

Conclusion: Presence of an NI was associated with improved clinical outcomes. This effect was more evident in patients with SAH. Patients with ICH tend to have poor outcomes regardless of the presence of a NCCU or a NI.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study Design
Figure 2
Figure 2
Time Period Analysis Study Design
Figure 3
Figure 3
Ischemic Stroke Demographics
Figure 4
Figure 4
Intracerebral Hemorrhage Demographics
Figure 5
Figure 5
Subarachnoid Hemorrhage Demographics
Figure 6
Figure 6
Ischemic Stroke: Univariate Analysis Outcomes
Figure 7
Figure 7
Intracerebral Hemorrhage: Univariate Analysis Outcomes
Figure 8
Figure 8
Subarachnoid Hemorrhage: Univariate Analysis Outcomes
See this image and copyright information in PMC

References

    1. Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29:635–640. - PubMed
    1. Hemphill JC, III, Bleck T, Carhuapoma R, et al. Is neurointensive care really optional for comprehensive stroke care? Stroke. 2005;36:2344–2345. - PubMed
    1. Alberts MJ, Latchaw RE, Selman WR, et al. Recommendations for comprehensive stroke centers: a consensus statement from the brain attack coalition. Stroke. 2005;36:1597–1616. - PubMed
    1. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38:2001–2023. - PubMed
    1. Bederson JB, Sander Connolly E, Batjer H, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40:994–1025. - PubMed