title: Impact of neurointensivist-managed intensive care unit implementation on patient outcomes after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  The purpose of the study is to evaluate the impact of neurointensivist-managed intensive care unit (NIM-ICU) implementation for patients admitted with aneurysmal subarachnoid hemorrhage (SAH).
  
  
  METHODS
  This study retrospectively evaluated 234 patients (mean age, 61.7 years; male, 67) admitted with SAH between January 1, 2001, and March 31, 2014. Neurologic outcomes between patients admitted from January 2001 to December 2006 (intensivist-managed intensive care unit group) and January 2007 to March 2014 (NIM-ICU group) were compared. The primary outcome was the incidence of a good neurologic outcome at discharge (GO; the modified Ranking Scale score: GO, 0-2; poor neurological outcome, 3-6) at discharge.
  
  
  RESULTS
  Neurointensivist-managed intensive care unit was initiated for 151 (64.5%) of 234 patients. Univariate analysis demonstrated significantly better outcomes for NIM-ICU group vs intensivist-managed intensive care unit group (GOs, 58.3% vs 41.0%, respectively, P = .01). Multivariate logistic regression was used to evaluate NIM-ICU efficacy for SAH patients, but NIM-ICU was not significantly associated with GOs (P = .054). Subgroup analysis of patient grading by Hunt and Kosnik grades I to II showed that NIM-ICU implementation was an independent predictor of GOs (odds ratio, 4.54; 95% confidence interval, 1.08-22.17; P = .04).
  
  
  CONCLUSIONS
  Neurointensivist-managed intensive care unit may improve neurologic outcomes in SAH patients with Hunt and Kosnik grades I to II.
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: s.egawa7701@gmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Egawa
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: hifumitoru@gmail.com.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: kenfact@kms.ac.jp.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: okauchi@med.kagawa-u.ac.jp.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Okauchi
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: ashindo@kms.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shindo
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: mk@kms.ac.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawanishi
authors.affiliation: Department of Neurosurgery, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: tamiya@kms.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamiya
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kagawa 761-0793, Japan. Electronic address: kuroday@kms.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D003422:Critical Care / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D020445:Hospitalists; D006801:Humans; D007362:Intensive Care Units; D002532:Intracranial Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D000078329:Workforce
keywords: Aneurysmal subarachnoid hemorrhage; Hunt and Kosnik grades; Modified Ranking Scale; Neurocritical care; Neurointensivist