Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

Neurocrit Care. 2020 Feb;32(1):88-103. doi: 10.1007/s12028-019-00835-z.

Abstract

Background: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study.

Methods: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality.

Results: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47).

Conclusion: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.

Keywords: Critical care; Neurocritical care; Observational study; Outcomes; Prospective.

Publication types

  • Observational Study

MeSH terms

  • Academic Medical Centers / statistics & numerical data
  • Adult
  • Aged
  • Asia / epidemiology
  • Brain Injuries, Traumatic / epidemiology
  • Brain Injuries, Traumatic / physiopathology
  • Brain Injuries, Traumatic / therapy*
  • Brain Neoplasms / epidemiology
  • Brain Neoplasms / physiopathology
  • Brain Neoplasms / therapy
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / physiopathology
  • Cerebral Hemorrhage / therapy*
  • Critical Care
  • Disease Management
  • Emergency Service, Hospital
  • Europe / epidemiology
  • Female
  • Glasgow Coma Scale
  • Health Resources
  • Heart Arrest / epidemiology
  • Heart Arrest / physiopathology
  • Heart Arrest / therapy
  • Hematoma, Subdural / epidemiology
  • Hematoma, Subdural / physiopathology
  • Hematoma, Subdural / therapy*
  • Hemodynamic Monitoring / statistics & numerical data
  • Hospital Mortality*
  • Hospitals, Private / statistics & numerical data
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Intensive Care Units
  • Internationality
  • Ischemic Stroke / epidemiology
  • Ischemic Stroke / physiopathology
  • Ischemic Stroke / therapy
  • Latin America / epidemiology
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Middle East / epidemiology
  • Multivariate Analysis
  • Neurophysiological Monitoring / statistics & numerical data
  • North America / epidemiology
  • Oceania / epidemiology
  • Odds Ratio
  • Palliative Care / statistics & numerical data
  • Patient Admission / statistics & numerical data
  • Patient Comfort
  • Patient Transfer / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Reflex, Pupillary
  • Resuscitation Orders
  • Risk Factors
  • Severity of Illness Index
  • Subarachnoid Hemorrhage / epidemiology
  • Subarachnoid Hemorrhage / physiopathology
  • Subarachnoid Hemorrhage / therapy*