Impact of a specialized neurointensive care team on outcomes of critically ill acute ischemic stroke patients.
OBJECTIVE
Dedicated stroke units are associated with improved patient outcomes after acute ischemic stroke in general. However, it is unknown whether the population of critically ill ischemic stroke patients admitted to the neurocritical care unit (NCCU) benefit from primary management by a specialized neurocritical care team (NCT). This study is intended to investigate such benefit.


METHODS
A retrospective chart review in a large academic university hospital identified 400 patients with acute ischemic stroke admitted to the NCCU, from January 1997 to April 2000, aged 65 +/- 14 years. We examined the short- and long-term outcomes of these patients before and after institution of a specialized NCT. We used logistic regression models to determine independent association between outcome and availability of NCT.


RESULTS
The presence of a NCT was associated with a decreased length of NCCU stay (2.9 +/- 2.0 vs. 3.7 +/- 2.9 days, P < 0.01), decreased length of hospital stay (7.5 +/- 4.7 vs. 9.9 +/- 7.6, P < 0.001), and increased proportion of home discharges (47% vs. 36%, P < 0.05). The only independent predictor of in-hospital and long-term mortality was the underlying severity of disease as determined by the APACHE III score.


CONCLUSIONS
In critically ill acute ischemic stroke patients, institution of a dedicated NCT was associated with a reduction in resource utilization and improved patient outcomes at hospital discharge. Several factors including improved patient care protocols may explain this association.
Bershad
Eric M
EM
Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB 302, Houston, TX 77030, USA.
Feen
Eliahu S
ES
Hernandez
Olga H
OH
Suri
M Fareed K
MF
Suarez
Jose I
JI
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000628:therapy*