Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.
Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients.


METHODS
We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months.


RESULTS
A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS.


CONCLUSIONS
Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.
1Department of Medicine,Division of Critical Care Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Mypinder S
MS
Sekhon
2Division of Neurosurgery,Department of Surgery,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Peter
P
Gooderham
2Division of Neurosurgery,Department of Surgery,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Brian
B
Toyota
2Division of Neurosurgery,Department of Surgery,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Navid
N
Kherzi
3Faculty of Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Vivien
V
Hu
1Department of Medicine,Division of Critical Care Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Vinay K
VK
Dhingra
1Department of Medicine,Division of Critical Care Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Morad S
MS
Hameed
1Department of Medicine,Division of Critical Care Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Dean R
DR
Chittock
1Department of Medicine,Division of Critical Care Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC,Canada.
Donald E
DE
Griesdale
D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D019468:Disease Management; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Brain tissue oxygen; Cerebral autoregulation; Intracranial pressure; Neurocritical care; Traumatic brain injury