This is a subject near and dear to my heart...jmr
Special Care Units Help Patients With Brain Diseases
NEW YORK, May 8, 2000 (Reuters Health) - Neurological intensive care
units (Neuro-ICUs) may be more effective in treating severe neurological
conditions than general ICUs are, according to new research.
Study author Dr. Michael Diringer, a neurologist at Washington
University School of
Medicine in St. Louis, Missouri, compared 1,038 patients with bleeding
in the brain
(intracerebral hemorrhage), and after adjusting for age, gender and the
severity of
hemorrhage, found that those admitted to Neuro-ICUs had a 35% mortality
rate as
compared to 40% for those admitted to general ICUs.
Age, the patient's alertness when admitted, and the ICU's familiarity
with the patient's
specific condition were other factors associated with higher mortality.
"In a generalized ICU, they may see a specific neurological problem once
or twice a year,
but in a Neuro-ICU, they see it once or twice a day," said Diringer in
an interview with
Reuters Health.
"The flip side is that it's a very inefficient way to run things," noted
Diringer who points out that hospitals often elect to have one larger
ICU than a bunch of small ones. "In the new
economies of medicine, we're forced to prove the things that we
intuitively think are correct, are in fact correct," Diringer explained.
Although the data indicates that patients in specialized ICUs do better,
the findings are
preliminary and there are many questions left to be answered. For
example, Diringer only
looked at the results from two Neuro-ICUs. "Maybe there is something
special about these
two ICUs that sort of swayed things," said Diringer. "I wouldn't
recommend that anyone run
out and change anything they're doing based on this, but I'd ask that
hospital administrators
pause and think about this. We can't just make arbitrary decisions
because it's more efficient
when it can affect patient outcome."
According to Diringer, the study needs to be replicated and there are
many questions that
still need to be answered in order to make the determination about the
appropriate ICU in
hospitals, such as, "Did people go home?" and "What quality of life do
they have now?"
The research was presented recently during the American Academy of
Neurology's 52nd
annual meeting, held in San Diego, California.
Copyright © 2000 Reuters Limited.
--
Judith Richards, London, Ontario, Canada
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