Neurological Outcome Beyond the ICU in Patients with Severe Acute Brain Injury: A Knowledge gap for ICU Teams.

Abstract

BackgroundIn patients with severe acute brain injury (SABI) admitted to the Intensive Care Unit (ICU) outcome is often uncertain. Physicians have to decide on continuation or withdrawal of life-sustaining therapy (WLST) in the first weeks. However, long-term neurological outcomes rarely reach the ICU team, limiting the opportunity to learn from decisions. This study aimed to assess the availability of long-term neurological outcome data and from which sources this could be retrieved.MethodsThis single-center retrospective observational study included all ICU survivors with SABI between January first and December 31^st 2022. Patient characteristics and neurological outcome data were extracted from the patient records. Neurological outcome was assessed using the Glasgow Outcome Scale Extended (GOSE) within 6 months after admission.ResultsA total of 65 patients were included, the median Glasgow Coma Scale (GCS) score at admission was 6 [IQR 4-7], the most common admission diagnosis was subarachnoid hemorrhage (34%). The mean ICU stay was 8 days (SD 8) and hospital stay 38 days (SD 29). Outcome data could be retrieved from neurology or neurosurgery outpatient clinic notes in 54% of patients, in 12% from the post-ICU clinic and in 2% from other hospitals, rehabilitation facilities and nursing homes. Mortality within 6 months was 26%. A favorable GOSE score (≥ 5) was found in 18 patients (28%), an unfavorable score in 42 patients (64%), and in 5 patients (8%) no outcome could be determined.ConclusionsFunctional recovery outcomes could be extracted from the patient records in nearly all ICU survivors with SABI. However, these outcomes were mostly identified from outpatient clinic notes from the neurology and neurosurgery department and it is uncertain whether these outcomes reach ICU physicians. A clear feedback loop is needed, to ensure ICU teams can learn from long-term patient trajectories and improve future patient care.