title: Do patients in a medical or surgical ICU benefit from a neurologic consultation?
abstract: Neurological complications are common in general medical and surgical intensive care units (ICU); they can prolong ICU and hospital stay and worsen outcome, including mortality. We performed a descriptive analysis of neurological consultations in non-neurological ICUs to determine the frequency of various neurological complications and to assess the diagnostic yield, therapeutic implications and prognostic benefit of these consultations. This is a retrospective single group cohort study of all neurological consultations for patients admitted to non-neurological (medical, respiratory care unit, cardiac, cardiothoracic, surgical and trauma) ICUs at Saint Marys Hospital (Mayo Clinic, Rochester) over a 24-month period (01 January 2010 to 31 December 2011). Equal numbers of neurological consultations (174, 50% each) were requested from medical ICUs and surgical ICUs. Altered consciousness (158, 45%), seizure (76, 22%) and focal deficits (75, 22%) were the most common reasons for consultations. Diagnostic, prognostic and therapeutic benefit was considered present in 89%, 38% and 39% patients respectively. Treatment change following neurological consultation occurred in 48% patients. Encephalopathy, stroke, seizure and anoxic brain injury were the most common causes of neurological complications in non-neurological ICUs with sedatives and opiates being the most common cause of encephalopathy. Almost half of the patients had change in treatment following neurological consultation. Neurological consultations in non-neurological ICU's are beneficial for patient's care in terms of diagnosis, treatment and prognosis.
authors.affiliation: 1Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D009460:Neurologic Examination; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: benefit; consultation; intensive care unit; neurology