Varelas Panayiotis N, Hacein-Bey Lotfi, Schultz Lonni, Conti Mary, Spanaki Marianna V, Gennarelli Thomas A
Department of Neurology, Henry Ford Hospital, K-11, 2799 West Grand Boulevard, Detroit, Michigan 48202, USA.
J Neurosurg. 2009 Aug;111(2):396-404. doi: 10.3171/2009.3.JNS08493.
The aim of this study was to examine the variables influencing the mode and location of death in patients admitted to a neurosurgical intensive care unit (NICU), including the participation of a newly appointed neurointensivist (NI).
Data from all patients admitted to a university hospital NICU were prospectively collected and compared between 2 consecutive 19-month periods before and after the appointment of an NI.
One thousand eighty-seven patients were admitted before and 1279 after the NI's appointment. The withdrawal of life support (WOLS) occurred in 52% of all cases of death. Death following WOLS compared with survival was independently associated with an older patient age (OR 1.04/year, 95% CI 1.03-1.05), a higher University Hospitals Consortium (UHC) expected mortality rate (OR 1.05/%, 95% CI 1.04-1.07), transfer from another hospital (OR 3.7, 95% CI 1.6-8.4) or admission through the emergency department (OR 5.3, 95% CI 2.4-12), admission to the neurosurgery service (OR 7.5, 95% CI 3.2-17.6), and diagnosis of an ischemic stroke (OR 5.4, 95% CI 1.4-20.8) or intracerebral hemorrhage (OR 5.7, 95% CI 1.9-16.7). On discharge from the NICU, 54 patients died on the hospital ward (2.7% mortality rate). A younger patient age (OR 0.94/year, 95% CI 0.92-0.96), higher UHC-expected mortality rate (OR 1.01/%, 95% CI 1-1.03), and admission to the neurosurgery service (OR 9.35, 95% CI 1.83-47.7) were associated with death in the NICU rather than the ward. There was no association between the participation of an NI and WOLS or ward mortality rate.
The mode and location of death in NICU-admitted patients did not change after the appointment of an NI. Factors other than the participation of an NI-including patient age and the severity and type of neurological injury-play a significant role in the decision to withdraw life support in the NICU or dying in-hospital after discharge from the NICU.
本研究旨在探讨影响神经外科重症监护病房（NICU）收治患者死亡方式和地点的变量，包括新任命的神经重症医学专家（NI）的参与情况。
前瞻性收集某大学医院NICU收治的所有患者的数据，并对NI任命前后连续两个19个月期间的数据进行比较。
NI任命前收治1087例患者，任命后收治1279例患者。在所有死亡病例中，52%发生了生命支持撤除（WOLS）。与存活相比，WOLS后的死亡与患者年龄较大（比值比[OR]为每年1.04，95%置信区间[CI]为1.03 - 1.05）、大学医院联合会（UHC）预期死亡率较高（OR为每百分点1.05，95% CI为1.04 - 1.07）、从其他医院转入（OR为3.7，95% CI为1.6 - 8.4）或通过急诊科入院（OR为5.3，95% CI为2.4 - 12）、入住神经外科（OR为7.5，95% CI为3.2 - 17.6）以及缺血性卒中（OR为5.4，95% CI为1.4 - 20.8）或脑出血（OR为5.7，95% CI为1.9 - 16.7）的诊断独立相关。从NICU出院时，54例患者在医院病房死亡（死亡率为2.7%）。患者年龄较小（OR为每年0.94，95% CI为0.92 - 0.96）、UHC预期死亡率较高（OR为每百分点1.01，95% CI为1 - 1.03）以及入住神经外科（OR为9.35，95% CI为
