Heewon Jeong, So Hee Park, Yoon-Hee Choo, Dong-Wan Kang, Yong Soo Kim, Bosco Seong Kyu Yang, Huimahn Alex Choi, Sung-Min Cho, Eun Jin Ha, Jiwoong Oh, Han-Gil Jeong
{"title":"急性脑损伤的流行病学模式和变异性：韩国神经危重症护理单位的多中心登记分析。","authors":"Heewon Jeong, So Hee Park, Yoon-Hee Choo, Dong-Wan Kang, Yong Soo Kim, Bosco Seong Kyu Yang, Huimahn Alex Choi, Sung-Min Cho, Eun Jin Ha, Jiwoong Oh, Han-Gil Jeong","doi":"10.1007/s12028-025-02313-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Specialized neurocritical care (NCC) improves outcomes in acute brain injury (ABI), but significant variability exists in practices across and hospitals within South Korea's developing national NCC system. This study aims to assess clinical variability among patients with ABI across six tertiary NCC units (NCCUs) in South Korea and evaluate center-specific effects on clinical outcomes.</p><p><strong>Methods: </strong>A multicenter registry of patients with ABI admitted to NCCUs between April 2023 and April 2024 was analyzed. A descriptive analysis was conducted to evaluate demographic, clinical, and treatment characteristics across centers. Variability across centers was quantified using the average standardized mean difference (SMD) for key variables. Mixed-effects and fixed-effects models compared center-specific effects on 6- and 12-month functional outcomes (utility-weighted modified Rankin scale [mRS] score), in-hospital mortality, length of NCCU stay, and tracheostomy rates.</p><p><strong>Results: </strong>Among 1,125 patients, 202 (18.2%) had aneurysmal subarachnoid hemorrhage, 478 (42.5%) had intracerebral hemorrhage, and 442 (39.3%) had traumatic brain injury. The median Glasgow Coma Scale (GCS) score was 13 (interquartile range 7-15). Notable differences (SMD > 0.2) were observed in premorbid mRS scores, initial clinical severity (e.g., GCS, pupillary response), treatment practices (e.g. intracranial pressure monitoring, vasospasm prophylaxis), and outcomes (e.g., 6-month mRS score). Hospital-specific effects did not significantly influence most outcomes; mixed-effects models showed no significant improvement in model fit for 6-month mRS scores (P = 0.78), in-hospital mortality (P = 0.99), length of NCCU stay (P = 0.12), and tracheostomy rates (P = 0.11), except for the 12-month mRS score (P = 0.01).</p><p><strong>Conclusions: </strong>Significant variability exists among patients with ABI across NCCUs in South Korea. Despite these differences, center-specific effects did not significantly influence key clinical outcomes closely related to NCCU care, suggesting that variability in outcomes may be more attributable to patient-level factors.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Epidemiological Patterns and Variability in Acute Brain Injury: A Multicenter Registry Analysis in South Korea's Neurocritical Care Units.\",\"authors\":\"Heewon Jeong, So Hee Park, Yoon-Hee Choo, Dong-Wan Kang, Yong Soo Kim, Bosco Seong Kyu Yang, Huimahn Alex Choi, Sung-Min Cho, Eun Jin Ha, Jiwoong Oh, Han-Gil Jeong\",\"doi\":\"10.1007/s12028-025-02313-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Specialized neurocritical care (NCC) improves outcomes in acute brain injury (ABI), but significant variability exists in practices across and hospitals within South Korea's developing national NCC system. This study aims to assess clinical variability among patients with ABI across six tertiary NCC units (NCCUs) in South Korea and evaluate center-specific effects on clinical outcomes.</p><p><strong>Methods: </strong>A multicenter registry of patients with ABI admitted to NCCUs between April 2023 and April 2024 was analyzed. A descriptive analysis was conducted to evaluate demographic, clinical, and treatment characteristics across centers. Variability across centers was quantified using the average standardized mean difference (SMD) for key variables. Mixed-effects and fixed-effects models compared center-specific effects on 6- and 12-month functional outcomes (utility-weighted modified Rankin scale [mRS] score), in-hospital mortality, length of NCCU stay, and tracheostomy rates.</p><p><strong>Results: </strong>Among 1,125 patients, 202 (18.2%) had aneurysmal subarachnoid hemorrhage, 478 (42.5%) had intracerebral hemorrhage, and 442 (39.3%) had traumatic brain injury. The median Glasgow Coma Scale (GCS) score was 13 (interquartile range 7-15). Notable differences (SMD > 0.2) were observed in premorbid mRS scores, initial clinical severity (e.g., GCS, pupillary response), treatment practices (e.g. intracranial pressure monitoring, vasospasm prophylaxis), and outcomes (e.g., 6-month mRS score). Hospital-specific effects did not significantly influence most outcomes; mixed-effects models showed no significant improvement in model fit for 6-month mRS scores (P = 0.78), in-hospital mortality (P = 0.99), length of NCCU stay (P = 0.12), and tracheostomy rates (P = 0.11), except for the 12-month mRS score (P = 0.01).</p><p><strong>Conclusions: </strong>Significant variability exists among patients with ABI across NCCUs in South Korea. Despite these differences, center-specific effects did not significantly influence key clinical outcomes closely related to NCCU care, suggesting that variability in outcomes may be more attributable to patient-level factors.</p>\",\"PeriodicalId\":19118,\"journal\":{\"name\":\"Neurocritical Care\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-07-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurocritical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12028-025-02313-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-025-02313-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Epidemiological Patterns and Variability in Acute Brain Injury: A Multicenter Registry Analysis in South Korea's Neurocritical Care Units.
Background: Specialized neurocritical care (NCC) improves outcomes in acute brain injury (ABI), but significant variability exists in practices across and hospitals within South Korea's developing national NCC system. This study aims to assess clinical variability among patients with ABI across six tertiary NCC units (NCCUs) in South Korea and evaluate center-specific effects on clinical outcomes.
Methods: A multicenter registry of patients with ABI admitted to NCCUs between April 2023 and April 2024 was analyzed. A descriptive analysis was conducted to evaluate demographic, clinical, and treatment characteristics across centers. Variability across centers was quantified using the average standardized mean difference (SMD) for key variables. Mixed-effects and fixed-effects models compared center-specific effects on 6- and 12-month functional outcomes (utility-weighted modified Rankin scale [mRS] score), in-hospital mortality, length of NCCU stay, and tracheostomy rates.
Results: Among 1,125 patients, 202 (18.2%) had aneurysmal subarachnoid hemorrhage, 478 (42.5%) had intracerebral hemorrhage, and 442 (39.3%) had traumatic brain injury. The median Glasgow Coma Scale (GCS) score was 13 (interquartile range 7-15). Notable differences (SMD > 0.2) were observed in premorbid mRS scores, initial clinical severity (e.g., GCS, pupillary response), treatment practices (e.g. intracranial pressure monitoring, vasospasm prophylaxis), and outcomes (e.g., 6-month mRS score). Hospital-specific effects did not significantly influence most outcomes; mixed-effects models showed no significant improvement in model fit for 6-month mRS scores (P = 0.78), in-hospital mortality (P = 0.99), length of NCCU stay (P = 0.12), and tracheostomy rates (P = 0.11), except for the 12-month mRS score (P = 0.01).
Conclusions: Significant variability exists among patients with ABI across NCCUs in South Korea. Despite these differences, center-specific effects did not significantly influence key clinical outcomes closely related to NCCU care, suggesting that variability in outcomes may be more attributable to patient-level factors.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
