Diagnostic Accuracy of Procalcitonin in Differentiating Sepsis from Noninfectious SIRS in Adult Patients with Subarachnoid Hemorrhage

Background: Subarachnoid hemorrhage (SAH) is a frequent diagnosis in the neuro-intensive care unit (NICU) that can result in the development of systemic inflammatory response syndrome (SIRS) and fever. The differentiation between central fever and infectious fever is paramount in order to prevent superfluous diagnostic testing and overuse of empiric antibiotics. Methods: A prospective chart review study conducted in the NICU between December 2012 and September 2015. Patients with SAH, fever (≥101.0°F) and/or who were SIRS positive and had PCT levels measured were included. The primary outcome was clinical infection defined as any positive culture or infiltrate on chest X-ray within three days of onset of fever. Results: Out of 129 patients, 54 were positive for any culture: 14 with PCT ≤0.2, 12 with PCT \u3e0.2 and ≤0.5, and 28 with PCT \u3e0.5. Using multiple logistic regression, PCT between 0.2-0.5 had an odds ratio of 2.99 (95% CI 1.12-8.00) while PCT \u3e0.5 had an odds ratio of 29.11 (CI 8.49-99.83) and p-value of \u3c0.001. All other predictors were not statistically significant. For procalcitonin \u3e0.5, specificity is 94.7%, sensitivity 51.9%, positive predictive value 87.5%, and negative predictive value 73.2%. ROC Curve area: 79.3%. Conclusion: PCT of 0.5 ng/mL or greater was useful for distinguishing infectious from central fever in SAH patients, with PCT values between 0.2-0.5 as somewhat predictive of infection. The test has high specificity and a reasonably high negative predictive value, so it can be a valuable tool to rule out infectious fever in patients with SAH

Improving Understanding Of and Compliance With Anti-Shivering Protocols During Therapeutic Hypothermia with Just-In-Time Training

Therapeutic hypothermia after cardiac arrest has been demonstrated to improve neurologic outcomes and survival rates following cardiac arrest. Shivering during hypothermia increases metabolic demand, increases oxygen consumption and increases difficulty maintaining desired temperatures. Gaps in knowledge can lead to inadequate management of shivering, leading Aims for Improvement To improve understanding of and compliance with anti-shivering protocols during therapeutic hypothermia post-cardiac arrest

Standardizing Postoperative Handoffs Using the Evidence-Based IPASS Framework Improves Handoff Communication for Postoperative Neurosurgical Patients in the Neuro-Intensive Care Unit

Aims for Improvement Within one year of initiation of the process improvement plan, we wanted to improve: Direct communication of airway and hemodynamic concerns Direct communication of operative events, complications, and perioperative management goals. Attendance at postoperative handoffs Confirmation of information by receiving teams Staff perceptions of handoff efficacy and teamwork

Incidence and Prevalence of Deep Vein Thrombosis Among Neurocritical Intensive Care Unit Patients

Background: Deep venous thrombosis (DVT) of the lower extremities is a common cause of morbidity and mortality among neurologically injured patients. The data on incidence and prevalence rates of DVT among high risk neurologic populations is scarce. The available literature focuses largely on patients admitted to a medical or surgical intensive care unit with very limited information on patients in neuro-intensive care units (NICU). The aim of the present study is to assess the incidence and prevalence of deep vein thrombosis among patients admitted with acute neurologic injury. Methods: We conducted a retrospective review of ultrasound records of 2,644 patients admitted to NICU, stroke or INICU at a university hospital over a 13-month period. We included all patients who underwent routine lower extremity ultrasound on admission and weekly. Data was abstracted and analyzed to assess the prevalence of DVT in this period. We excluded patients presenting with superficial vein thrombosis, hematoma and chronic venous scarring. Results: Among the 2,644 patients studied, 161 were diagnosed with DVT. The overall prevalence of DVT was 6.1%. Of the 161 cases of DVT; 87 (54%) were diagnosed with DVT at the time of admission. In our sample, the rate of DVT present on admission was 3.3%. There were 74 cases of hospital-acquired DVT, yielding an incidence of 2.8%. Patients with DVT at the time of admission were largely Caucasian males with mean age 72 and mean SAPS II score of 34.2, ranging between 13 and 71. Conclusions: Patients admitted to a neuro ICU are at high risk for having DVT present on admission and for acquiring DVT during their hospitalization. Further research is needed to understand the risk profile of patients with acute neurological injury. Asymptomatic screening of high risk patients on admission to a neurologic ICU, stroke unit, or intermediate care unit will identify a significant number of cases of DVT present of admission that might otherwise be misidentified as hospital acquired cases

The Prevalence and Risk Factors of Acute Myocardial Infarction (AMI) After Acute Ischemic Stroke (AIS) in the United States

Objectives: To determine the prevalence and risk factors for, and the association with in-hospital mortality of, AMI after AIS, and to study the effect of intravenous recombinant tissue plasminogen activator (r-tPA) in this setting. We hypothesized that AMI would be associated with lower survival rate at hospital discharge but that intravenous r-tPA would be associated with lower risk of AMI

Implementation of Attending-Supervised IPASS Handoff in the Neuro-ICU

Background Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties These handoffs are well-known points of communication breakdown which can lead to patient safety issues Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of carehttps://jdc.jefferson.edu/patientsafetyposters/1077/thumbnail.jp

Improving Postoperative Handoffs in the Neuro-Intensive Care Unit

Introduction Transitions of care represent a major source of medical errors, patient morbidity/mortality, and increased healthcare waste. 2018 CLER report indicated largely unfavorable responses toward handoffs and care transitions for perioperative services and neurointensive care. Use of the IPASS handoff tool is associated with up to 30% reduction in adverse events and 23% reduction in medical errors. Implementation of IPASS for postoperative handoffs in the SICU resulted in improved organization, safety, and communication.https://jdc.jefferson.edu/patientsafetyposters/1146/thumbnail.jp