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

PRINCE Study Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalNeurocritical care
DOIs
StateAccepted/In press - Jan 1 2019

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Patient Care
Intensive Care Units
Hospital Mortality
Glasgow Coma Scale
Patient Admission
Length of Stay
Logistic Models
Patients' Rooms
Resource Allocation
Subarachnoid Hemorrhage
Pupil
North America
Surveys and Questionnaires
Critical Illness
Observational Studies
Hospital Emergency Service
Comorbidity
Emergencies
Cross-Sectional Studies
Research Personnel

Keywords

  • Critical care
  • Neurocritical care
  • Observational study
  • Outcomes
  • Prospective

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

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

In: Neurocritical care, 01.01.2019.

Research output: Contribution to journalArticle

@article{2ecf583350f14c59aabecd917f93deb7,
title = "Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2",
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",
author = "{PRINCE Study Investigators} and {Venkatasubba Rao}, {Chethan P.} and Suarez, {Jose I.} and Martin, {Renee H.} and Colleen Bauza and Alexandros Georgiadis and Eusebia Calvillo and Hemphill, {J. Claude} and Gene Sung and Mauro Oddo and Taccone, {Fabio Silvio} and LeRoux, {Peter D.} and Gustavo Domeniconi and Camputaro, {Luis Alberto} and Milton Villalobos and Mariela Allasia and Goldenberg, {Fernando D.} and Teran, {Mario D.} and Foda Rosciani and Hector Alvarez and Marcelo Costilla and Diego Perez and Pablo Raffa and Walter Videtta and Ian Seppelt and Helen Rodgers and Jody Paxton and Deepak Bhonagiri and Anders Aneman and Elizabeth Jenkinson and Celia Bradford and Simon Finfer and Elizabeth Yarad and Francess Bass and Naomi Hammond and Anne O’Connor and Simon Bird and Roger Smith and Jane Shilkin and Wpd Woods and Brigit Roberts and Michael O’Leary and Shirley Vallance and Raimund Helbok and Ronny Beer and Bettina Pfaulser and Alois Schiefecker and Ayesha Almemari and Sajid Mukaddam and Jennifer Berkeley and Marek Mirski",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s12028-019-00835-z",
language = "English (US)",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",

}

TY - JOUR

T1 - Global Survey of Outcomes of Neurocritical Care Patients

T2 - Analysis of the PRINCE Study Part 2

AU - PRINCE Study Investigators

AU - Venkatasubba Rao, Chethan P.

AU - Suarez, Jose I.

AU - Martin, Renee H.

AU - Bauza, Colleen

AU - Georgiadis, Alexandros

AU - Calvillo, Eusebia

AU - Hemphill, J. Claude

AU - Sung, Gene

AU - Oddo, Mauro

AU - Taccone, Fabio Silvio

AU - LeRoux, Peter D.

AU - Domeniconi, Gustavo

AU - Camputaro, Luis Alberto

AU - Villalobos, Milton

AU - Allasia, Mariela

AU - Goldenberg, Fernando D.

AU - Teran, Mario D.

AU - Rosciani, Foda

AU - Alvarez, Hector

AU - Costilla, Marcelo

AU - Perez, Diego

AU - Raffa, Pablo

AU - Videtta, Walter

AU - Seppelt, Ian

AU - Rodgers, Helen

AU - Paxton, Jody

AU - Bhonagiri, Deepak

AU - Aneman, Anders

AU - Jenkinson, Elizabeth

AU - Bradford, Celia

AU - Finfer, Simon

AU - Yarad, Elizabeth

AU - Bass, Francess

AU - Hammond, Naomi

AU - O’Connor, Anne

AU - Bird, Simon

AU - Smith, Roger

AU - Shilkin, Jane

AU - Woods, Wpd

AU - Roberts, Brigit

AU - O’Leary, Michael

AU - Vallance, Shirley

AU - Helbok, Raimund

AU - Beer, Ronny

AU - Pfaulser, Bettina

AU - Schiefecker, Alois

AU - Almemari, Ayesha

AU - Mukaddam, Sajid

AU - Berkeley, Jennifer

AU - Mirski, Marek

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Critical care

KW - Neurocritical care

KW - Observational study

KW - Outcomes

KW - Prospective

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U2 - 10.1007/s12028-019-00835-z

DO - 10.1007/s12028-019-00835-z

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JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

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