Stone Jonathan Jay, Childs Sean, Smith Lindsay Erin, Battin Megan, Papadakos Peter J, Huang Jason H
Neurol Res. 2014 Feb;36(2):164-9. doi: 10.1179/1743132813Y.0000000285.
Hourly neurologic assessments for traumatic brain injury (TBI) in the critical care setting are common practice but prolonged use may actually be harming patients through sleep deprivation. We reviewed practice patterns at our institution in order to gain insight into the role of frequent neurological assessments.
A 6-month retrospective review was performed for patients who were admitted to an intensive care unit (ICU) with the diagnosis of TBI. Electronic medical records were reviewed based on billing codes. Variables collected included but were not limited to patient demographics, frequency of nursing neurologic evaluations, Glasgow coma scale (GCS), length of stay (LOS), and disposition.
A total of 124 patients were identified, 71% male with the average age of 52 years (range 19-96). Traumatic brain injury was classified as severe in 44, moderate in 18, and mild in 62 patients. A total of 89 (71.8%) patients underwent hourly nursing assessments for an average of 2.82 days. The median LOS for all patients was 7 days (range 0-109). There were 18 patients who remained on hourly neurological assessments for greater than 4 days and had a greater LOS (23 days vs 9 days, P = 0.001). Only two patients required surgery after 48 hours, both for chronic subdural hematomas.
Hourly neurologic checks are necessary in the acute period for patients with potentially expansible intracranial hemorrhages or malignant cerebral edema, but prolonged use may be harmful. Patients with a low probability of requiring neurosurgical intervention may benefit from reducing the total duration of hourly assessments.
在重症监护环境中，对创伤性脑损伤（TBI）患者进行每小时一次的神经功能评估是常见的做法，但长期这样做实际上可能会因睡眠剥夺而对患者造成伤害。我们回顾了我们机构的实践模式，以便深入了解频繁进行神经功能评估的作用。
对入住重症监护病房（ICU）且诊断为TBI的患者进行了为期6个月的回顾性研究。根据计费代码审查电子病历。收集的变量包括但不限于患者人口统计学信息、护理神经功能评估的频率、格拉斯哥昏迷量表（GCS）、住院时间（LOS）和出院情况。
共确定了124例患者，其中71%为男性，平均年龄52岁（范围19 - 96岁）。44例患者的创伤性脑损伤被分类为重度，18例为中度，62例为轻度。共有89例（71.8%）患者接受了每小时一次的护理评估，平均时长为2.82天。所有患者的中位住院时间为7天（范围0 - 109天）。有18例患者连续每小时进行神经功能评估超过4天，且住院时间更长（23天对9天，P = 0.001）。48小时后只有2例患者需要手术，均为慢性硬膜下血肿。
对于有潜在可扩展性颅内出血或恶性脑水肿的患者，急性期每小时进行神经功能检查是必要的，但长期使用可能有害。需要神经外科干预可能性较低的患者可能会从减少每小时评估的总时长中受益。
