The impact of a neuro-intensivist on patients with stroke admitted to a neurosciences intensive care unit.
BACKGROUND
Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU).


METHODS
Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate analyses.


RESULTS
One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the period after the NI. Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs. 54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period (Cox proportional hazard ratios, 95% CI were 2.37, 1.4-4.1 and 1.8, 1.04-3 for IS, 1.98, 1.3-3 and 1.2, 0.8-1.9 for ICH, and 1.6, 1.1-2.3 and 1.4, 1.01-2 for SAH, respectively) or for all strokes (1.92, 1.52-2.43 and 1.7, 1.28-2.25 for the first 12 days of hospital admission).


CONCLUSIONS
The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.
Varelas
Panayiotis N
PN
Department of Neurology, Henry Ford Hospital, K-11, 2799 West Grand Blvd, Detroit, MI 48202, USA. varelas@neuro.hfh.edu
Schultz
Lonni
L
Conti
Mary
M
Spanaki
Marianna
M
Genarrelli
Thomas
T
Hacein-Bey
Lotfi
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology; D009493:Neurosurgery; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D000078329:Workforce