Neurologic complications of critical medical illnesses

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ObjectivesTo identify the neurologic complications of critical medical illnesses, and to assess their effect on mortality rates and on medical ICU and hospital lengths of stay.DesignProspective clinical evaluation of all medical ICU admissions for 2 yrs.SettingA 14-bed, general medical intensive and coronary care unit in a large university hospital.PatientsPatients (n = 1,850) admitted to the hospital, of whom 92 were admitted for primarily neurologic problems. Of the remaining 1,758 patients, 217 (12.3%) experienced a neurologic complication.InterventionsNone.Measurements and Main ResultsPatients developing a neurologic complication while in the medical ICU demonstrated an increased risk of inhospital mortality when compared with patients who did not suffer such problems (45.7% vs. 26.6%; p < .00001). Patients with neurologic complications experienced 2.5-fold longer medical ICU stay times (p < .001) and almost two-fold longer hospital stay times (p < .001). Metabolic encephalopathy, seizures, hypoxic-ischemic encephalopathy, and stroke were the most common complications. Sepsis was the most frequent cause of encephalopathy, and cerebrovascular lesions were the most common cause of seizures. Formal neurologic consulttions were requested in only 36% of the patients.ConclusionsNeurologic complications associated with increased mortality rates longer medical ICU and hospital lengths of st These conditions are probably underrecognis at present. ICUs have the potential to serve environments for neurologic teaching and search. (Crit Care Med 1993; 21:98–103)

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