Abstract
Objectives Neurocritical care (NCC) is a rapidly developing subspecialty which aims to improve outcomes of critically ill neurological patients, although its effect is yet to be determined. We performed a systematic review and meta-analysis to evaluate the impact of neurocritical care units (NCCU) or teams on patient outcomes.
Methods Three electronic databases were systematically searched (MEDLINE, Embase, CENTRAL) up to December 2021, and by citation chaining, for studies comparing specialised NCC to general care for acutely brain-injured adults. The primary outcome was all-cause mortality at longest follow-up. Secondary outcomes were intensive care unit (ICU) length of stay (LOS), hospital LOS and functional outcomes. Random-effects meta-analyses were performed for all outcomes with R.
Results Following screening of 5659 non-duplicated published records, 26 non-randomised observational studies fulfilled inclusion criteria. A meta-analysis of mortality outcomes for 55792 patients demonstrated 17% relative risk reduction (RR 0.83, 95% CI 0.75–0.92) in those cared for in a NCCU or by NCC specialised staff, compared to general care. Subgroup analyses by disease and intervention type did not identify subgroup differences. Eight studies of 4667 patients demonstrated 17% relative risk reduction (RR 0.83, 95% CI 0.70–0.97) for an unfavourable functional outcome with subspecialised care compared to general care. There were no differences in LOS outcomes. Heterogeneity was substantial in all analyses.
Conclusions Subspecialised NCC are associated with improved survival and functional outcomes for critically ill brain-injured adults. Further investigations are necessary to determine the specific aspects of care in NCCUs that contribute to these improved outcomes.
