title: How does care differ for neurological patients admitted to a neurocritical care unit versus a general ICU?
abstract: BACKGROUND
  Neurological patients have lower mortality and better outcomes when cared for in specialized neurointensive care units than in general ICUs. However, little is known about how the process of care differs between these types of units.
  
  
  METHODS
  The Greater New York Hospital Association conducted a city-wide 24-h ICU prevalence survey on March 15th, 2007. Data was collected on all patients admitted to 143 ICUs in 69 different hospitals.
  
  
  RESULTS
  Of 1,906 ICU patients surveyed, 231 had a primary neurological diagnosis. Of these, 52 (22%) were admitted to one of 9 neuro-ICU's in NY and 179 (78%) to a medical or surgical ICU. Neurological patients in neuro-ICUs were more likely to have been transferred from an outside hospital (37% vs. 11%, P < 0.0001). Hemorrhagic stroke was more frequent in neuro-ICUs (46% vs. 16%, P < 0.0001), whereas traumatic brain injury (2% vs. 24%, P < 0.0001) and ischemic stroke (0% vs. 19%, P = 0.001) were less common. Despite a lower rate of mechanical ventilation (39% vs. 50%, P = 0.15), ICU length of stay was longer in neuro-ICU patients (≥10 days, 40% vs. 17%, P < 0.0001). More neuro-ICU patients had undergone tracheostomy (35% vs. 15%, P = 0.04), invasive hemodynamic monitoring (40% vs. 20%, P = 0.002), and invasive intracranial pressure monitoring (29% vs. 9%, P < 0.001) than patients cared for in general ICUs. Intravenous sedation was less prevalent in neuro-ICUs (12% vs. 30%, P = 0.009) and more patients were receiving nutritional support compared to general ICUs (67% vs. 39%, P < 0.001).
  
  
  CONCLUSIONS
  Neurological patients cared for in specialty neuro-ICUs underwent more invasive intracranial and hemodynamic monitoring, tracheostomy, and nutritional support, and received less IV sedation than patients in general ICUs. These differences in care may explain previously observed disparities in outcome between neurocritical care and general ICUs.
authors.affiliation: The Department of Neurology, Columbia University, New York, NY, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Kurtz
authors.forename: Vincent
authors.initials: V
authors.lastname: Fitts
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Sumer
authors.forename: Hillary
authors.initials: H
authors.lastname: Jalon
authors.forename: Joseph
authors.initials: J
authors.lastname: Cooke
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kvetan
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000628:therapy*; D002544:Cerebral Infarction / Q000628:therapy*; D003131:Combined Modality Therapy; D016292:Procedural Sedation; D006801:Humans; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000628:therapy; D007902:Length of Stay; D008991:Monitoring, Physiologic; D009519:New York City; D010043:Outcome and Process Assessment, Health Care; D010288:Parenteral Nutrition; D010343:Patient Admission; D011787:Quality of Health Care; D012121:Respiration, Artificial; D020521:Stroke / Q000628:therapy*