Parameters Affecting Length of Stay Among Neurosurgical Patients in an Intensive Care Unit

Aim: to determine the predictive factors on the length of stay of neurosurgical patients in the ICU setting. Methods: all patients admitted to the neurosurgical ICU between February 1 and July 31, 2011 were recruited. Patient demographics and clinical data for each variable were collected within 30 minutes of admission. The ICU length of stay was recorded and analyzed by linear regression model with statistical significance at p-value <0.05. Results: there were 276 patients admitted, of whom 89.1% were elective cases. The mean (95% CI) and median (min-max) of ICU length of stay were 2.36 (2.09-2.63) and 2 (1-25) days. The variables associated with ICU length of stay and their percent change (95% CI) were the Glasgow Coma Scale motor subscore (GCSm), 6.72% (-11.20 to -2.01) lower for every 1 point score change; blood pH, 1.16% (0.11 to 2.21) higher for every 0.01 unit change; and emergency admission type, 58.30% (29.16 to 94.0) higher as compared to elective admission. Conclusion: the GCSm, pH and emergency admission were found to be the main predictive variables of neurosurgical patient length of stay in the intensive care unit, however, the model should be further explored in a larger sample size and using subgroup analysis

Sustav APACHE II. kao klinički prediktor u neurokirurškoj jedinici intenzivnog liječenja

The APACHE II scoring system is approved for its benchmarking and mortality predictions, but there are only a few articles published to demonstrate it in neurosurgical patients. Therefore, this study was performed to acknowledge this score and its predictive performance to hospital mortality in a tertiary referral neurosurgical intensive care unit (ICU). All patients admitted to the Neurosurgical ICU from February 1 to July 31, 2011 were recruited. The parameters indicated in APACHE II score were collected. The adjusted predicted risk of death was calculated and compared with the death rate observed. Descriptive statistics including the receiver operating characteristic curve (ROC) was performed. The results showed that 276 patients were admitted during the mentioned period. The APACHE II score was 16.56 (95% CI, 15.84-17.29) and 19.08 (95% CI, 15.40- 22.76) in survivors and non-survivors, while the adjusted predicted death rates were 13.39% (95% CI, 11.83-14.95) and 17.49% (95% CI, 9.81-25.17), respectively. The observed mortality was only 4.35%. The area under the ROC of APACHE II score to the hospital mortality was 0.62 (95% CI, 0.44-0.79). In conclusion, not only the APACHE II score in neurosurgical patients indicated low severity, but its performance to predict hospital mortality was also inferior. Additional studies of predicting mortality among these critical patients should be undertaken.Sustav APACHE II. odobren je kao mjerilo i prediktor smrtnosti, no samo se nekoliko članaka bavi njegovom primjenom kod neurokirurških bolesnika. Stoga smo proveli ovo istraživanje kako bismo potvrdili ovaj sustav i njegovu sposobnost predviđanja bolničke smrtnosti u referentnoj tercijarnoj neurokirurškoj jedinici intenzivnog liječenja (JIL). U istraživanje su bili uključeni svi bolesnici primljeni u neurokiruršku JIL od 1. veljače do 31. srpnja 2011. godine. Prikupljeni su podaci koji se odnose na parametre sustava APACHE II. Izračunat je prilagođeni rizik smrti i uspoređen sa zabilježenom stopom smrtnosti. U analizi je primijenjena deskriptivna statistika uključujući ROC. Rezultati su pokazali da je primljeno 276 bolesnika. Zbir APACHE II. bio je 16,56 (95% CI, 15,84-17,29) za preživjele i 19,08 (95% CI, 15,40-22,76) za umrle, dok je prilagođena predviđena stopa smrtnosti bila 13,39% (95% CI, 11,83-14,95) odnosno 17,49% (95% CI, 9,81-25,17). Zabilježena stopa smrtnosti bila je samo 4,35%. Područje ispod ROC zbira APACHE II. za bolničku smrtnost iznosila je 0,62 (95% CI, 0,44-0,79). U zaključku, ne samo da je zbir APACHE II. pokazao nisku težinu kod neurokirurških bolesnika, nego je i njegov rezultat u predviđanju bolničke smrtnosti bio nezadovoljavajući. Treba provesti daljnja istraživanja prediktora smrtnosti kod ovih kritičnih bolesnika

Analgesic Prescription Patterns and Pain Outcomes in Southeast Asia: Findings From the Analgesic Treatment of Cancer Pain in Southeast Asia Study

Purpose :To identify patterns of analgesic prescription and to explore patient-reported pain intensity, sleep disturbance, and quality of life among cancer patients with pain in Southeast Asia (SEA). Methods: This cross-sectional observational study included 465 adult outpatients prescribed analgesics for cancer pain for 1 month or longer at 22 sites in Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam. Data on analgesic prescription and cancer characteristics were extracted from medical records. Pain intensity, sleep disturbance, and quality of life measures were recorded via questionnaires. Results: Most patients (84.4%) had stage III or IV cancer. A total of 419 patients (90.7%) were prescribed opioids; of these, 42.2% received only weak opioids, whereas 57.8% received at least one strong opioid. The mean worst pain intensity during the past 24 hours was 4.76 (standard deviation [SD], 2.47) on a scale of 0 (no pain) to 10 (worst possible pain); the mean current pain intensity was 4.10 (SD, 2.61). More than half of patients (54.8%) reported sleep disturbance caused by pain in the past 7 days. The majority of patients reported problems with pain/discomfort (82.3%), usual activities (65.8%), mobility (58.2%), and anxiety/depression (56.3%). The median daily dose prescribed in oral morphine equivalents was 30 mg for both morphine and tramadol. Conclusion: Despite unrelieved pain, sleep disturbance, and issues with quality of life, a notable proportion of patients were prescribed only weak opioids, and opioid doses prescribed were generally low. Efforts focused on encouragement of prescriptions with analgesic strength and/or doses proportional to the pain management needs of patients are vital to improve the status of cancer pain management in the region

Patient and Physician Satisfaction with Analgesic Treatment: Findings from the Analgesic Treatment for Cancer Pain in Southeast Asia (ACE) Study

Aim. The aim of this study was to examine patients' and physicians' satisfaction, and concordance of patient-physician satisfaction with patients' pain control status. Methods. This cross-sectional observational study involved 465 adults prescribed analgesics for cancer-related pain from 22 sites across Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam. Pain intensity, pain control satisfaction, and adequacy of analgesics for pain control were documented using questionnaires. Results. Most patients (84.4%) had stage III or IV cancer. On a scale of 0 (no pain) to 10 (worse pain), patients' mean worst pain intensity over 24 hours was 4.76 (SD 2.47). More physicians (19.0%) than patients (8.0%) reported dissatisfaction with patient's pain control. Concordance of patient-physician satisfaction was low (weighted kappa 0.36; 95% CI 0.03-0.24). Most physicians (71.2%) found analgesics to be adequate for pain control. Patients' and physicians' satisfaction with pain control and physician-assessed analgesic adequacy were significantly different across countries (P<0.001 for all). Conclusions. Despite pain-related problems with sleep and quality of life, patients were generally satisfied with their pain control status. Interestingly, physicians were more likely to be dissatisfied with patients' pain control. Enhanced patient-physician communication, physicians' proactivity in managing opioid-induced adverse effects, and accessibility of analgesics have been identified to be crucial for successful cancer pain management. This study was registered at ClinicalTrials.gov (identifier NCT02664987)