Critical Care Medicine | 2019
805: DEVELOPMENT AND EVOLUTION OF A NEUROCRITICAL CARE PROGRAM
Abstract
Learning Objectives: Neuro-Critical Care (NCC) is a subspecialty that focuses on neurologic disease and dysfunction in the critical care setting. It is thought that development of a program can improve patient outcomes and care in this patient population. However, the perception of a role and benefit of such a program can be unclear among pediatric intensivists, neurologists, and neurosurgeons. We aim to outline the development and growth of a NCC program at Ann & Robert H. Lurie Children’s Hospital of Chicago, formerly Children’s Memorial Hospital. Methods: A comprehensive review of a manual NCC database was performed. The review was performed to provide an overview of information about the program throughout the duration of its existence from 2005–2018. Specific areas of review included number of consultations per year, consultation diagnoses, and correlation with significant events within the institution. Results: At the time of program inception in 2005, the service was consulted on a total of 152 patients. The program grew exponentially over the years, and is now on track to see upwards of over 700 patients in 2018. Diagnoses seen during consultation (by category) include: ischemic stroke, traumatic brain injury (TBI) (inflicted), TBI (accidental), status epilepticus, autoimmune disorder, encephalopathy/hypoxic ischemic encephalopathy (HIE), Posterior Reversible Encephalopathy Syndrome (PRES), CNS infection, intracranial hemorrhage, CNS tumor, neuromuscular disorder, hydrocephalus, metabolic/degenerative disorder, and vascular event. The most prevalent underlying diagnosis for NCC consultation is status epilepticus (344), followed by encephalopathy/HIE (342). Significant events within the institution included: the move of Children’s Memorial Hospital to Ann & Robert H. Lurie Children’s Hospital of Chicago in 2012, the NCC program expansion to the Neonatal Intensive Care Unit (NICU) in 2015, and expansion of the Cardiac Care Unit (CCU) in 2018. Conclusions: Ann & Robert H. Lurie Children’s Hospital of Chicago has successfully developed a NCC program as a consulting service for PICU, CCU, and NICU departments. Over a 13-year time course, we have seen steady increases in the number and location of consultations, along with expanding reasons for consultation.