Neurologic complications of critical medical illnesses.
OBJECTIVE
To identify the neurologic complications of critical medical illnesses, and to assess their effect on mortality rates and on medical ICU and hospital lengths of stay.


METHODS
Prospective clinical evaluation of all medical ICU admissions for 2 yrs.


METHODS
A 14-bed, general medical intensive and coronary care unit in a large university hospital.


METHODS
Patients (n = 1,850) admitted to the hospital, of whom 92 were admitted for primarily neurologic problems. Of the remaining 1,758 patients, 217 (12.3%) experienced a neurologic complication.


METHODS
None.


RESULTS
Patients developing a neurologic complication while in the medical ICU demonstrated an increased risk of inhospital mortality when compared with patients who did not suffer such problems (45.7% vs. 26.6%; p < .00001). Patients with neurologic complications experienced 2.5-fold longer medical ICU stay times (p < .001) and almost two-fold longer hospital stay times (p < .001). Metabolic encephalopathy, seizures, hypoxic-ischemic encephalopathy, and stroke were the most common complications. Sepsis was the most frequent cause of encephalopathy, and cerebrovascular lesions were the most common cause of seizures. Formal neurologic consultations were requested in only 36% of these patients.


CONCLUSIONS
Neurologic complications are associated with increased mortality rates and longer medical ICU and hospital lengths of stay. These conditions are probably underrecognized at present. ICUs have the potential to serve as environments for neurologic teaching and research.
Bleck
T P
TP
Department of Neurology, University of Virginia School of Medicine, Charlottesville 22908.
Smith
M C
MC
Pierre-Louis
S J
SJ
Jares
J J
JJ
Murray
J
J
Hansen
C A
CA
D001424:Bacterial Infections / Q000150:complications; D001927:Brain Diseases / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000150:complications; D002641:Chicago; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008659:Metabolic Diseases / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology*; D011446:Prospective Studies; D012640:Seizures / Q000209:etiology / Q000628:therapy