title: Retrospective agreement and consent to neurocritical care is influenced by functional outcome.
abstract: BACKGROUND
  Only limited data are available on consent and satisfaction of patients receiving specialized neurocritical care. In this study we (i) analyzed the extent of retrospective consent to neurocritical care--given by patients or their relatives--depending on functional outcome one year after hospital stay, and (ii) identified predisposing factors for retrospective agreement to neurocritical care.
  
  
  METHODS
  We investigated 704 consecutive patients admitted to a nonsurgical neurocritical care unit over a period of 2 years (2006 through 2007). Demographic and clinical parameters were analyzed, and the patients were grouped according to their diagnosis. Functional outcome, retrospective consent to neurocritical care, and satisfaction with hospital stay was obtained by mailed standardized questionnaires. Logistic regression analyses were calculated to determine independent predictors for consent.
  
  
  RESULTS
  High consent and satisfaction after neurointensive care (91% and 90%, respectively) was observed by those patients who reached an independent life one year after neurointensive care unit (ICU) stay. However, only 19% of surviving patients who were functionally dependent retrospectively agreed to neurocritical care. Unfavorable functional outcome and the diagnosis of stroke were independent predictors for missing retrospective consent.
  
  
  CONCLUSIONS
  Retrospective agreement to neurocritical care is influenced by functional outcome. Especially in severely affected stroke patients who cannot communicate their preferences regarding life-sustaining therapy, neurocritical care physicians should balance the expected burdens and benefits of treatment to meet the patients' putative wishes. Efforts should be undertaken to identify predictors for severe disability after neurocritical care.
authors.affiliation: Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany. ines-christine.kiphuth@uk-erlangen.de
authors.forename: Ines C
authors.initials: IC
authors.lastname: Kiphuth
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Joji B
authors.initials: JB
authors.lastname: Kuramatsu
authors.forename: Christoph
authors.initials: C
authors.lastname: Mauer
authors.forename: Lorenz
authors.initials: L
authors.lastname: Breuer
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003422:Critical Care / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology / Q000706:statistics & numerical data; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult