The one-year case registry in a neurological intensive care unit

The critical care of patients with neurological diseases is one of the fastest growing specialties in neurology. However, only a few hospitals have neurological intensive care units (neuro-ICUs) dedicated to neurological care and directed by neurologists. We analyzed the demographic data and clinical profiles of patients admitted to neuro-ICUs at the Shin Kong Wu Ho-Su Memorial Hospital (SKH) to provide the basic information of the current status of neuro-ICUs in Taiwan. We reviewed the prospective register and retrospective review of patients admitted to the neuro-ICU at SKH from November 1999 through November 2000. There were 230 patients (115 males and 115 females) and their ages ranged from 19 to 100 with a mean of 63.4 years. The indications for admission to the neuro-ICU included impaired consciousness for 118 (51.3%) patients, unstable neurological signs or vital signs for 63 (27.4%), neuromuscular weakness requiring ventilator support for 14 (6.1%), status epilepticus for 14 (6.1%), acute ischemic stroke for thrombolytic therapy for seven (3.0%) and others for 12 (5.2%). The most common diagnoses were hemispheric infarcts for 55 (24.0%) patients, brain stem and cerebellar infarcts for 35 (15.2%), intracerebral hemorrhages for 32 (13.9%), metabolic and other diffuse encephalopathies for 18 (7.8%), head injuries for 15 (6.5%), myasthenia gravis for 13 (5.6%), and CNS infections for 10 (4.3%). The mean ICU stay for all the patients was 9.3 days and the mortality rate was 19.1%. The most common complication was pneumonia for 95 (41.3%) patients, followed by urinary tract infections for 45 (19.6%) and sepsis for 13 (5.6%). Patients with complications of nosocomial infections had higher mortality rates (p<0.01) and significantly prolonged ICU stays (p<0.0001). The present study provides the basic information of disease distribution, length of stay, morbidity rates, mortality rates, and complications. This may be used for developing treatment strategies, critical care pathways for the different diseases, and monitoring for quality of care and cost.