NeuroICU FastTrack: Rapid Disposition of Patients with Intracerebral Hemorrhage from the Emergency Department to Neuro-ICU.

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-04-25 DOI:10.1007/s12028-025-02247-8
Nicolle W Davis, Jeannette M Hester, Brandon Allen, Christina Wilson, Anna Khanna, Ashley E Magnuson, Teng J Peng, Katharina M Busl, Amita Singh
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引用次数: 0

Abstract

Background: Emergency department length of stay (EDLOS) directly impacts outcomes of critically ill patients, with the risk of in-hospital mortality increasing by nearly 40% when an intensive care unit (ICU) bed is delayed beyond 4 h. Patients with intracerebral hemorrhage (ICH) suffer from worse functional outcomes and higher mortality when EDLOS exceeds 5 h, even for EDLOS exceeding just 1 h. Our goal was to implement an expedited triage pathway to reduce EDLOS of patients with ICH to less than 3 h and evaluate for downstream reduced morbidity and mortality.

Methods: We conducted a retrospective analysis of patients with ICH evaluated in the emergency department (ED) at an academic comprehensive stroke center between January 1, 2022, and June 30, 2023. Univariate and multivariate logistic regression analyses were conducted to investigate the association between the NeuroICU FastTrack intervention with EDLOS less than 3 h and the rate of in-hospital mortality.

Results: A total of 234 patients with ICH arrived to the ED and were admitted to the neuro-ICU. Post implementation, there was a statistically significant decrease in EDLOS from an average of 6.6 h to 4 h (p < 0.001) and a significant decrease in patient mortality (p = 0.006). There was also a reduction in mortality to 9.3% (p = 0.006) compared to a preintervention mortality rate of 22.9%. Additionally, the morbidity outcome (mRS of 0-2) remained relatively constant in both groups preintervention (23%) to post intervention (28%).

Conclusions: Consistent with prior published evidence and National Institute of Neurological Disorders and Stroke recommendations, a shorter EDLOS significantly decreased mortality, but there was no difference in morbidity in our population. The NeuroICU FastTrack process expedited critically ill ICH patient throughput from the ED to the ICU, enhanced bed availability through streamlined procedures, and improved patient outcomes.

神经icu快速通道:脑出血患者从急诊科到神经icu的快速处置。
背景:急诊科住院时间(EDLOS)直接影响危重患者的预后,当重症监护病房(ICU)床位延迟超过4小时时,住院死亡风险增加近40%。脑出血(ICH)患者的功能预后较差,EDLOS超过5小时时死亡率较高。我们的目标是实施一种快速的分诊途径,将脑出血患者的EDLOS减少到3小时以下,并评估下游降低的发病率和死亡率。方法:我们对2022年1月1日至2023年6月30日期间在一家学术综合脑卒中中心急诊科(ED)评估的脑出血患者进行了回顾性分析。采用单因素和多因素logistic回归分析,探讨EDLOS小于3 h的NeuroICU快速通道干预与住院死亡率之间的关系。结果:共有234例脑出血患者到达急诊科并入住神经icu。实施后,EDLOS从平均6.6小时减少到4小时,具有统计学意义(p)。结论:与先前发表的证据和国家神经疾病和卒中研究所的建议一致,较短的EDLOS显著降低了死亡率,但在我们的人群中发病率没有差异。NeuroICU快速通道流程加快了重症脑出血患者从急诊科到ICU的吞吐量,通过简化程序提高了床位的可用性,并改善了患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
期刊介绍: Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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