Value of neurocritical care

Mortality
The Point PRevalence In Neurocritical CarE (PRINCE) study analyzed data from 1545 neurocritically ill ICU patients at 147 sites in 31 countries around the world. They found that the presence of a dedicated NeuroICU was associated with a decreased risk of mortality (OR 0.58, 95% CI 0.41-0.95). This is in line with data from a 2014 meta-analysis of 19 studies (n=41,391) showing a reduction in mortality for patients cared for in a NeuroICU (OR 0.72, 95% CI 0.59-0.89).

Care led by a neurointensivist specifically is also associated with lower mortality (OR 0.85, 95% CI 0.74-0.98).

Functional outcome
A meta-analysis of 16 prior studies (n=29,019) showed that the presence of a dedicated NeuroICU was associated with a lower odds or poor functional outcome (OR 0.70, 95% 0.61-0.81).

Care led by a neurointensivist specifically is also associated with improved discharge home mortality (OR 1.38, 95% CI 1.15-1.66)

Common procedures

 * Arterial line: 22%
 * Gastrostomy tube: 21%
 * Mechanical ventilation: 19%
 * Tracheostomy: 19%
 * External ventricular drain: 7.5%
 * Central venous catheter: 4%
 * ICP monitors: 1.8%
 * Brain tissue oxygen monitoring: 0.6%
 * Jugular bulb oximetry: 0.1%
 * Cerebral microdialysis: 0.1%

Statistics

 * Median age: 58 (IQR 44-70)
 * Median length of stay: 7 days (IQR 3-16 days) in ICU, 13 days (IQR 6-24) in hospital
 * In-hospital mortality: ~12%
 * Median number of NeuroICU beds: 15 (10-20), higher in the US (18, IQR 13-23.5) than the rest of the world (10, IQR 8-16)
 * End-of-life care
 * DNR: 15%
 * Comfort measures: 11%
 * Palliative care consultation: 7%