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Worldwide Organization of Neurocritical Care: Results from the PRINCE Study Part 1

Abstract

Introduction

Neurocritical care focuses on the care of critically ill patients with an acute neurologic disorder and has grown significantly in the past few years. However, there is a lack of data that describe the scope of practice of neurointensivists and epidemiological data on the types of patients and treatments used in neurocritical care units worldwide. To address these issues, we designed a multicenter, international, point-prevalence, cross-sectional, prospective, observational, non-interventional study in the setting of neurocritical care (PRINCE Study).

Methods

In this manuscript, we analyzed data from the initial phase of the study that included registration, hospital, and intensive care unit (ICU) organizations. We present here descriptive statistics to summarize data from the registration case report form. We performed the Kruskal–Wallis test followed by the Dunn procedure to test for differences in practices among world regions.

Results

We analyzed information submitted by 257 participating sites from 47 countries. The majority of those sites, 119 (46.3%), were in North America, 44 (17.2%) in Europe, 34 (13.3%) in Asia, 9 (3.5%) in the Middle East, 34 (13.3%) in Latin America, and 14 (5.5%) in Oceania. Most ICUs are from academic institutions (73.4%) located in large urban centers (44% > 1 million inhabitants). We found significant differences in hospital and ICU organization, resource allocation, and use of patient management protocols. The highest nursing/patient ratio was in Oceania (100% 1:1). Dedicated Advanced Practiced Providers are mostly present in North America (73.7%) and are uncommon in Oceania (7.7%) and the Middle East (0%). The presence of dedicated respiratory therapist is common in North America (85%), Middle East (85%), and Latin America (84%) but less common in Europe (26%) and Oceania (7.7%). The presence of dedicated pharmacist is highest in North America (89%) and Oceania (85%) and least common in Latin America (38%). The majority of respondents reported having a dedicated neuro-ICU (67% overall; highest in North America: 82%; and lowest in Oceania: 14%).

Conclusion

The PRINCE Study results suggest that there is significant variability in the delivery of neurocritical care. The study also shows it is feasible to undertake international collaborations to gather global data about the practice of neurocritical care.

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References

  1. 1.

    Smith M. Neurocritical care: has it come of age? Br J Anaesth. 2004;93:753–5.

  2. 2.

    Bleck T. Critical care and emergency neurology. In: Cohen MM, editor. The American Academy of Neurology: the first 50 years 1948–1998. St. Paul: American Academy of Neurology; 1998. p. 225–7.

  3. 3.

    Ropper AH. Neurological intensive care. Ann Neurol. 1992;32:564–9.

  4. 4.

    Rincon F, Mayer SA. Neurocritical care: A distinct discipline? Curr Opin Crit Care. 2007;13:115–21.

  5. 5.

    www.neurocriticalcare.org. Accessed 05 June 2018.

  6. 6.

    Mayer SA, Coplin WM, Chang C, et al. Program requirements for fellowship training in neurological intensive care: United Council for Neurologic Subspecialties guidelines. Neurocrit Care. 2006;5:166–71.

  7. 7.

    Mayer SA, Coplin WM, Chang C, et al. Core curriculum and competencies for advanced training in neurological intensive care: United Council for Neurologic Subspecialties guidelines. Neurocrit Care. 2006;5:159–65.

  8. 8.

    https://www.strobe-statement.org/index.php?id=available-checklists. Accessed 02 January 2019.

  9. 9.

    Suarez JI, Geocadin R, Hall C, Le Roux PD, Smirnakis S, Wijman CAC, Zaidat OO. The Neurocritical Care Research Network: NCRN. Neurocrit Care. 2012;16:29–34.

  10. 10.

    www.commondataelements.ninds.nih.gov/. Accessed 05 June 2018.

  11. 11.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

  12. 12.

    http://www.project-redcap.org/. Accessed 05 June 2018.

  13. 13.

    Venkatasubba Rao CP, Suarez JI, Martin RH, Bauza C, Georgiadis A, Calvillo E, et al. Global survey of outcomes of neurocritical care patients: analysis of the PRINCE Study Part 2. Neurocrit Care. 2019.

  14. 14.

    Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376:1339–46.

  15. 15.

    Dunser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med. 2006;34:1234–42.

  16. 16.

    Fowler RA, Adhikari NK, Bhagwanjee S. Clinical review: critical care in the global context—disparities in burden of illness, access, and economics. Crit Care. 2008;12:225.

  17. 17.

    Vincent JL, Marshall JC, Ñamendys-Silva SA, FranÇois B, Martin-Loeches I, Lipman J, Reinhart K, Antonelli M, Pickkers P, Njimi H, Jimenez E, Sakr Y, the ICON investigators. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. Lancet Respir Med. 2014;2:380–6.

  18. 18.

    Martin A, Chen ML, Chaterjee A, Merkler AE, Chung CD, Wu X, Morris NA, Kamel H. Specialty classifications of physicians who provide neurocritical care in the United States. Neurocrit Care. 2019;30:177–84.

Download references

Acknowledgements

We thank the following individuals for their great support and help with the PRINCE Study: Amanda Simons from the BCM IT Department for her help setting up the electronic database; Kimberly Weiderhold from the BCM legal department for assisting with Data Use Agreements; Jean Louis Vincent from the Free University of Brussels for providing us with copies of CRFs from the ICON Study; Ian Seppelt from the University of Sydney for helping us with the ANZICS-CTG sites; Katja Wartenberg from Martin Luther University, Germany, for facilitating interactions with IGNITE and MENA.

Author information

JIS protocol development, data collection, data analysis, and manuscript writing/editing; RHM data collection, data management, data analysis, and manuscript writing/editing; CB data collection, data management, data analysis, and manuscript writing/editing; Alexandros Georgiadis: protocol development, data collection, data analysis, and manuscript writing/editing; Chethan P. Venkatasubba Rao: protocol development, data collection, data analysis, and manuscript writing/editing; EC protocol development, data collection, data analysis, and manuscript writing/editing; JCH protocol development, data collection, data analysis, and manuscript writing/editing; MO protocol development, and manuscript writing/editing; FST protocol development, and manuscript writing/editing; PDL protocol development, and manuscript writing/editing. The corresponding author confirms that authorship requirements have been met, the final manuscript was approved by ALL authors, and that this manuscript has not been published elsewhere and is not under consideration by another journal. There was no support for this work. The PRINCE Study adhered to ethical guidelines and the IRB at the Baylor College of Medicine approved it with a waiver of consent. We used the STROBE reporting checklist for observational studies.

Correspondence to Jose I. Suarez.

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Conflict of interest

Dr Suarez reports being President of the Neurocritical Care Society, a member of the Editorial Board of Stroke Journal, and Chair of the DSMB for the INTREPID Study sponsored by BARD, outside of the submitted work. Dr LeRoux has nothing to disclose. Dr Bauza has nothing to disclose. Dr Sung has nothing to disclose. Dr Hemphill has nothing to disclose. Dr Oddo has nothing to disclose. Dr Martin has nothing to disclose. Dr Taccone has nothing to disclose. Dr Georgiadis has nothing to disclose. Dr Venkatasubba Rao has nothing to disclose. Ms Calvillo has nothing to disclose.

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See complete listing of the PRINCE Study Investigators in Appendix A (Supplementary material).

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Supplementary material 1 (DOCX 21 kb)

Supplementary material 2 (DOCX 19 kb)

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Suarez, J.I., Martin, R.H., Bauza, C. et al. Worldwide Organization of Neurocritical Care: Results from the PRINCE Study Part 1. Neurocrit Care 32, 172–179 (2020). https://doi.org/10.1007/s12028-019-00750-3

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Keywords

  • Neurocritical care
  • Observational study
  • Outcomes
  • Critical care
  • Prospective