One-year survival of patients admitted to the neurological intensive care unit

Introduction

Patient survival in neurological intensive care units (NICUs) may be obvious; however, there is currently little evidence regarding the longer term outcome of these patients. In this study the 1-year survival of NICU patients has been defined.

Methods

Between April 2004 and April 2005, all patients admitted to the NICU requiring ≥24 hours of ≥2 organ system support were identified (n = 175). The year following admission was divided into three phases – early (0–30 days), middle (31–90 days) and late (91–360 days) – and mortality was recorded. Data were analysed using Kaplan–Meier and log-rank analysis.

Results

Patients were admitted from many sources; interhospital transfers (n = 90), neurosurgical admissions (n = 26), medical admissions (n = 36), and emergency admissions (n = 15). Reasons for admission included haemorrhage (n = 66), trauma (n = 52) and neoplasm (n = 19). Ninety-one patients (52.0%) spent less than 7 days on the NICU and 84 (48%) required ≥7 days. Overall survival was 70.9% at 30 days and 61.1% at 1 year. There was no significant variation between the young (<60 years) and older (≥60 years) groups (62.6%, n = 115 vs 58.3%, n = 60, P > 0.5). Nor was there a difference between those receiving two organ support and those receiving ≥3 organ support (62.1%, n = 66 vs 60.6%, n = 109, P > 0.5). Mortality (deaths/30 days) varied dramatically between the early, middle and late phases (29.1% vs 3.2% vs 0.9%, P < 0.001).

Conclusion

Although mortality is high during the first 30 days of neurological critical illness there is a significant plateau in the survival curve; patients surviving beyond the initial phase tend to survive long term. Larger studies may be beneficial to further evaluate subgroup variation in the survival curve profile.

Figure 1