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The effect of secular trends and specialist neurocritical care on mortality for patients with intracerebral haemorrhage, myasthenia gravis and Guillain–Barré syndrome admitted to critical care

An analysis of the Intensive Care National Audit & Research Centre (ICNARC) national United Kingdom database

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Abstract

Purpose

To analyse mortality for spontaneous intracerebral haemorrhage (ICH), myasthenia gravis (MG) and Guillain–Barré syndrome (GBS) from 1996 to 2009 in UK intensive care units (ICUs).

Methods

We used the Intensive Care National Audit & Research Centre (ICNARC) database. We identified specialised neurosciences critical care units (NCCUs) (n = 16), general ICUs with full neurological support (n = 48) and general ICUs with limited neurological support (n = 138) and undertook descriptive analyses for each condition. Poisson regression was used to identify trends in admission rates, median regression to identify trends in lengths of stay (LOS), and logistic regression (Wald test) to analyse interaction between unit type and time period; odds ratios were calculated for hospital mortality associated with unit types.

Results

For ICH (n = 10,313 cases), overall ICU mortality was 42.4 %, and acute hospital mortality 62.1 %. In NCCU, LOS was longer, but mortality lower, and over time, mortality from ICH decreased faster. For MG (n = 1,064 cases) and GBS (n = 1,906 cases), overall mortality was relatively high (MG: 8.7 % ICU mortality and 22 % acute hospital mortality; GBS: 7.7 and 16.7 %, respectively); overall mortality did not decrease over time.

Conclusions

This first large-scale analysis of outcomes in acute neurological disease in the UK demonstrates real-life mortality higher than published series. NCCU care is associated with increased survival in conditions requiring highly specialised intensive care techniques, but high-quality step-down care is pivotal in others. Strategies that truly improve outcomes must integrate emergency department management, ICU admission criteria, NCCU treatment, high-quality step-down care and neurorehabilitation.

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Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

Support for the collection and use of anonymised patient data without individual consent was obtained under Section 251 of the NHS Act 2006 (approval number PIAG 2–10(f)/2005). Additional ethics committee approval for gathering these anonymised data is not required, and this study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Neurosciences Critical Care Unit and Department of Neurology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK

    Maxwell S. Damian

  2. Ipswich Hospital, Ipswich, IP5 4PD, UK

    Maxwell S. Damian

  3. School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK

    Yoav Ben-Shlomo

  4. The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Robin Howard

  5. St. Thomas’ Hospital, London, SE1 7EH, UK

    Robin Howard

  6. Department of Mathematics, Imperial College London, London, SW7 2AZ, UK

    Tony Bellotti

  7. ICNARC, Napier House, 24 High Holborn, London, WC1V 6AZ, UK

    David Harrison, Kathryn Griggs & Kathryn Rowan

Authors
  1. Maxwell S. Damian
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  2. Yoav Ben-Shlomo
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  3. Robin Howard
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  5. David Harrison
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Correspondence to Maxwell S. Damian.

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Damian, M.S., Ben-Shlomo, Y., Howard, R. et al. The effect of secular trends and specialist neurocritical care on mortality for patients with intracerebral haemorrhage, myasthenia gravis and Guillain–Barré syndrome admitted to critical care. Intensive Care Med 39, 1405–1412 (2013). https://doi.org/10.1007/s00134-013-2960-6

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  • DOI: https://doi.org/10.1007/s00134-013-2960-6

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