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Impact of Neurointensivist Co-Management in a Semiclosed Neurocritical-Care Unit

Journal of Clinical Neurology 2020년 16권 4호 p.681 ~ 687
김상화, 염규선, 정진헌, 최재형, 박현석, 송영진, 김대현, 차재관, 한문구,
소속 상세정보
김상화 ( Kim Sang-Hwa ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery
염규선 ( Yum Kyu-Sun ) - Chungbuk National University Hospital Department of Neurology
정진헌 ( Jeong Jin-Heon ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurology
최재형 ( Choi Jae-Hyung ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery
박현석 ( Park Hyun-Seok ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery
송영진 ( Song Young-Jin ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery
김대현 ( Kim Dae-Hyun ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurology
차재관 ( Cha Jae-Kwan ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurology
한문구 ( Han Moon-Ku ) - Seoul National University Bundang Hospital Department of Neurology

Abstract


Background and Purpose: The importance of the specialized management of neurocritical patients is being increasingly recognized. We evaluated the impact of neurointensivist comanagement on the clinical outcomes (particularly the mortality rate) of neurocritical patients admitted to a semiclosed neurocritical-care unit (NCU).

Methods: We retrospectively included neurocritical patients admitted to the NCU between March 2015 and February 2018. We analyzed the clinical data and compared the outcomes between patients admitted before and after the initiation of neurointensivist co-management in March 2016.

Results: There were 1,785 patients admitted to the NCU during the study period. Patients younger than 18 years (n=28) or discharged within 48 hours (n=200) were excluded. The 1,557 remaining patients comprised 590 and 967 who were admitted to the NCU before and after the initiation of co-management, respectively. Patients admitted under neurointensivist co-management were older and had higher Acute Physiologic Assessment and Chronic Health Evaluation II scores. The 30-day mortality rate was significantly lower after neurointensivist co-management (p=0.042). A multivariate logistic regression analysis demonstrated that neurointensivist co-management significantly reduced mortality rates in the NCU and in the hospital overall [odds ratio=0.590 (p=0.002) and 0.585 (p=0.001), respectively].

Conclusions: Despite the higher severity of the condition during neurointensivist co-management, co-management significantly improved clinical outcomes (including the mortality rate) in neurocritical patients.

키워드

intensive care unit; critical care; critical care outcomes; mortality

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