入住专科神经重症监护病房及其与临床结局的关联。

Admission to specialised neurocritical units and association with clinical outcomes.

作者信息

Pham Xiuxian, Chaba Anis, Serpa Neto Ary, Litton Edward, Pilcher David, Laing Joshua, Perucca Piero, Kwan Patrick, O'Brien Terence, Udy Andrew

机构信息

Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.

出版信息

J Clin Neurosci. 2025 Sep;139:111471. doi: 10.1016/j.jocn.2025.111471. Epub 2025 Jul 12.

DOI:10.1016/j.jocn.2025.111471

PMID:40652886

Abstract

BACKGROUND

Globally, managing critically ill adults with acute brain injuries (ABIs) in specialised neurocritical units (NCCUs) is associated with improved survival, but this has not been assessed in Australia. This study aims to determine in adults with an ABI if admission to a general intensive care unit (ICU) or a NCCU was associated with a difference in outcomes.

METHODS

Australian ICUs were surveyed regarding NCCU capabilities via the Australian and New Zealand Intensive Care Society (ANZICS). Linked patient-level outcomes were extracted from the ANZICS Adult Patient Database for a retrospective observational cohort study. Adults with an ABI (intracerebral haemorrhage, acute ischaemic stroke, subarachnoid haemorrhage or traumatic brain injury) admitted to ICU between January 2016 and December 2022 were included. Readmissions within the same hospital, transfers from another ICU and admissions for end-of-life care or organ donation were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were ICU mortality, ICU length of stay (LOS), hospital LOS and discharge destination other than home.

RESULTS

Responses were received from 78 out of 192 surveyed ICUs. Amongst these, 41 reported routinely caring for ABI patients, of which 8 were specialist NCCUs. There were 14,740 index admissions to participating ICUs over the study period, with 7,402 NCCU and 7,338 general ICU admissions respectively. Crude in-hospital mortality was 18% (1,356/7,402) in NCCUs and 21% (1,514/7,338) in general ICUs. The adjusted odds ratio (OR) for in-hospital mortality was 0.88 (95% confidence interval [CI] 0.81-0.96, p-value 0.003), favouring those cared for in a NCCU. In survivors, those admitted to NCCUs were more likely to remain in hospital longer (relative change in geometric mean = 20.5%, 95% CI 16.2-25.1, p-value < 0.001) and less likely to be discharged home (OR = 2.01, 95% CI 1.83-2.21).

CONCLUSION

In Australian adult ABI patients admitted to ICU, admission to a NCCU was independently associated with lower hospital mortality. However, in survivors, this was associated with a lower likelihood of being discharged home and a longer stay in hospital. Variable intensive care capabilities for neurocritical care may impact key patient-centred outcomes. Future research is required to assess long-term functional outcomes.

摘要

背景

在全球范围内，在专门的神经重症监护病房（NCCU）中管理患有急性脑损伤（ABI）的重症成人患者与生存率提高相关，但在澳大利亚尚未对此进行评估。本研究旨在确定患有ABI的成人患者入住综合重症监护病房（ICU）或NCCU是否与结局差异相关。

方法

通过澳大利亚和新西兰重症监护学会（ANZICS）对澳大利亚的ICU进行了关于NCCU能力的调查。从ANZICS成人患者数据库中提取相关患者层面的结局，进行一项回顾性观察队列研究。纳入2016年1月至2022年12月期间入住ICU的患有ABI（脑出血、急性缺血性中风、蛛网膜下腔出血或创伤性脑损伤）的成人患者。排除同一医院内的再次入院、从另一个ICU的转院以及临终关怀或器官捐赠的入院情况。主要结局是住院死亡率。次要结局包括ICU死亡率、ICU住院时间（LOS）、医院住院时间和非回家的出院目的地。

结果

192个接受调查的ICU中有78个回复。其中，41个报告常规护理ABI患者，其中8个是专科NCCU。在研究期间，参与的ICU共有14740例首次入院患者，分别有7402例入住NCCU和7338例入住综合ICU。NCCU的粗住院死亡率为18%（1356/7402），综合ICU为21%（1514/7338）。住院死亡率的调整比值比（OR）为0.88（95%置信区间[CI]0.81 - 0.96，p值0.003），表明入住NCCU的患者更具优势。在幸存者中，入住NCCU的患者更有可能住院时间更长（几何均值相对变化 = 20.5%，95%CI 16.2 - 25.1，p值 < 0.001），且出院回家的可能性更小（OR = 2.01，95%CI 1.83 - 2.21）。