Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury.

BACKGROUND: We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). METHODS: The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. RESULTS: A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. CONCLUSIONS: In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.

Prevalence of Post Traumatic Stress Disorder, Anxiety and Depression among COVID-19 survivors 1 year after Intensive Care discharge.

BACKGROUND: Survivors of Intensive Care are known to be at increased risk of developing longer-term psychopathology issues. AIM: The aim of this study was to determine the prevalence of posttraumatic stress disorder, anxiety and depression among COVID-19 survivors 1 year after discharge from an Italian Intensive Care Unit (ICU). METHODS: We conducted a cross-sectional study between April and August 2021 among 86 adults COVID-19 survivors in Lecco (Italy). The PTSD was measured using the PTSD-checklist (PCL), HADS scale was used to measure anxiety and depression. Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables. RESULTS: The mean PTSD, anxiety and depression scores were (38.6 6.3), (5.1 3.8), (6.9 3.7) respectively. Based on cut-off scores, the prevalence of PTSD (PCL ≥ 45), anxiety (HADs score ≥ 8) and depression (HADs score ≥ 8) were (n = 20, 23.2%) (n = 22, 25.6%) and (n = 38, 44.2%) respectively. COVID-19 survivors who experienced a decreased level of exercise post-ICU discharge were more likely to show symptoms of depression (AOR = 2.57; 95%CI: 1.31-6.85, p = 0.027) and anxiety (AOR = 3.19; 95%CI: 1.29-8.32, p = 0.021) compared to those whose exercise remained the same post-ICU discharge. In addition Older COVID survivors were more likely to show symptoms of depression (AOR = 8.2, 95% CI: 1.97-24.45, p = 0.001) and anxiety (AOR = 3.26; 95%CI: 1.12-8.1, p = 0.022) compared to younger ones. CONCLUSIONS: Our findings show that PTSD, anxiety and depression are common among the COVID-19 survivors in Lecco. NURSING IMPLICATIONS: Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease.

Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study.

BACKGROUND: Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. PURPOSE: A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. METHODS: In this before-and-after study, data were collected before (T0) and after (T1) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores. RESULTS: The main outcome measure was pain recollection a year after discharge; secondary outcome measures were the use and doses of sedatives and analgesics. A significantly (p = .037) smaller proportion of patients treated after protocol adoption recollected feeling severe pain compared with patients treated before the protocol was introduced. This group also received significantly (p < .001) fewer sedatives and significantly (p = .0028) more anti-inflammatory drugs and analgesics on an "as needed" basis. The administration of strong analgesics was similar in the two groups. The intervention was implemented in 70.5% of patients with intermediate to high pain scores. CONCLUSIONS: Appropriately trained ICU nurses have the potential to help adopt pain relief and prevention measures during nursing care and to contribute to the successful management of sedation and analgesia. Further studies of larger patient samples are needed to monitor the stability of results over time and to explore the efficacy of the approach in other populations, such as pediatric and neonatal ICU patients.