Utility of the neurologic intensive care evaluation (NICE) in detecting neurologic deficit after cardiac operations--a pilot study.
BACKGROUND
Neurocognitive changes are common after cardiac operations. The acute post-operative period is a critical time when significant neurologic changes may be detected and appropriate therapy initiated promptly. Formal neuropsychologic testing in this situation however is impractical so other means of early detection are required. The goal of this preliminary study was to determine whether simple, standardized, serial nursing neurologic evaluations using the Neurologic Intensive Care Evaluation (NICE) could be helpful in screening patients for neurologic injury in the immediate post-operative period.


METHODS
Details of the intra-operative and post-operative anesthetic management were obtained during report and nurses subsequently scored acute post-operative patients in the CTSICU using the NICE every half hour for the first five hours. Finally, a chart review was performed to determine the neurologic outcome of the patients.


RESULTS
The time to achieve the lower NICE scores which reflect mainly brainstem function was the same whereas the time to achieve NICE scores>4 was prolonged in patients with neurocognitive dysfunction. The effect of intra-operative factors on the times to achieve NICE scores was different for the higher and lower scores. The times to reach NICE scores correlated with outcome variables including the time in ICU and time of intubation.


CONCLUSIONS
Standardized, serial nursing neurologic assessments of post-operative cardiac patients may be a useful tool for early identification of patients with neurologic injury. They may also provide useful information complementing the data obtained from detailed neuropsychologic testing on the neurologic effects of cardiac operations.
Baker
Susan
S
Department of Cardio-Thoracic Surgery, Hospital of the University of Pennsylvania, PA, USA.
Beauchamp
Kimberly
K
Ballinghoff
James
J
Escherich
Alison
A
Cheung
Albert T
AT
Stecker
Mark M
MM
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis*; D011184:Postoperative Period; D020196:Trauma, Nervous System / Q000175:diagnosis* / Q000209:etiology