Author : Victoria Anne McCredie
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (133 download)
Book Synopsis Processes and Structures of Care for Critically Ill Patients with Acute Brain Injury by : Victoria Anne McCredie
Download or read book Processes and Structures of Care for Critically Ill Patients with Acute Brain Injury written by Victoria Anne McCredie and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Examining the differences in quality and intensity of care within the context of ICU structure is needed to better understand the mortality differences observed between centers, and may help to improve the design of future trials for this neurocritically ill patient population. Methods: This dissertation uses several methods to examine the relationship between processes, organization of care and outcome for critically ill patients with acute brain injury. Results: First in a cohort study, I evaluated the association between centers rendering early decisions to withdraw life-sustaining therapies in severe traumatic brain injury (sTBI), as measured by time until death, and overall risk-adjusted mortality. After adjustment for case mix, care in a center with a preponderance of early deaths (within the first 5 days of ICU admission) was not associated with increased odds of death (adjusted odds ratio (OR) 0.95; 95% confidence interval (CI) 0.83-1.09). Secondly in a meta-analysis, I examined the relationship between the timing of tracheostomy in acutely brain injured patients and mortality. Early tracheostomy was associated with lower long-term mortality (risk ratio [RR] 0.57. 95% CI 0.36-0.90), reduced duration of mechanical ventilation (mean difference [MD] -2.72 days, 95% CI -1.29 to -4.15) and ICU length of stay (MD -2.55 days, 95% CI -0.50 to -4.59), but, was not associated with lower short-term mortality (RR 1.25; 95% CI 0.68-2.30), and, as expected, increased the probability of ever receiving a tracheostomy (RR 1.58, 95% CI 1.24-2.02). Lastly in a cohort study combined with survey data, I examined the association between dedicated neurocritical care units, the presence of standardized management protocols for sTBI, and mortality. Care in a dedicated neurocritical care unit was not associated with a lower risk-adjusted in-hospital mortality (OR 0.97 (95% CI 0.80-1.19), but the utilization of standardized TBI management protocols for these patients was associated with lower risk-adjusted in-hospital mortality (OR 0.77; 95% CI 0.63-0.93). Conclusions: Using several analytical approaches, these findings highlight important opportunities to reduce variability in care negatively impacting on acute brain injury outcomes.