Objective

Critical treatment and management have advanced over the recent decades, bringing many benefits but also causing increasing complication rates. Among these complications, neurological complications have an important place and may increase in mortality rates. The aim of our study was to find the causes of neurological consultations in the level 3 adult intensive care units (ICU).

Methods

The study population consisted of patients who were requested to have neurology consultation in the level 3 Adult ICUs between April 2013 and April 2017. The records in the hospital automation system of patients required neurology consultation were evaluated retrospectively.

Results

A total of 906 neurology consultations were requested in ICUs and 302 patients were included in this study. Altered consciousness and unconsciousness (32.1%), seizure (26.5%), management and treatment (15.9%) were the most common reasons for neurological consultations. Epileptic seizures (16.9%), status epilepticus (9.3%) and ischemic stroke (8.6%) were the most common final neurological diagnoses after consultation. Wernicke encephalopathy, posterior reversible encephalopathy syndrome, motor neuron disease, Creutzfeldt-Jakob disease, critical illness polyneuropathy and critical illness myopathy were less frequently diagnosed (< 1%).

The diagnostic benefit was 83.1%. Treatment change following neurological consultation occurred in 56.6% of the patients.

Conclusions

In our study, spanning a period of 4 years, the most common diagnoses were epileptic seizure, status epilepticus, and ischemic stroke. More frequent complications, such as stroke and seizure, as well as less common complications such as Wernicke's encephalopathy and posterior reversible encephalopathy syndrome, should be intervened immediately. In case of consultation, neurologists should be able to manage neurological complications as a consultant physician in the early period and evaluate the ICU patient systematically and be familiar with the complexity of intubation, sedation and sometimes paralyzed intensive ICU patients who have had severely limited routine clinical evaluations.

中文翻译：

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重症监护室的神经病学咨询

客观的

近几十年来，重症治疗和管理取得了进展，带来了许多好处，但也导致并发症发生率增加。在这些并发症中，神经系统并发症占有重要地位，并可能增加死亡率。我们研究的目的是找出在 3 级成人重症监护室 (ICU) 进行神经科会诊的原因。

方法

研究人群包括 2013 年 4 月至 2017 年 4 月期间被要求在 3 级成人 ICU 进行神经内科会诊的患者。对医院自动化系统中需要神经内科会诊的患者的记录进行回顾性评估。

结果

本研究共要求在 ICU 进行 906 次神经内科会诊，其中 302 名患者被纳入。意识和无意识改变（32.1%）、癫痫发作（26.5%）、管理和治疗（15.9%）是神经科会诊的最常见原因。癫痫发作 (16.9%)、癫痫持续状态 (9.3%) 和缺血性中风 (8.6%) 是咨询后最常见的最终神经系统诊断。Wernicke 脑病、后部可逆性脑病综合征、运动神经元病、Creutzfeldt-Jakob 病、危重病多发性神经病和危重病肌病的诊断率较低（< 1%）。

诊断获益为 83.1%。56.6% 的患者在神经科会诊后改变了治疗方案。

结论

在我们为期 4 年的研究中，最常见的诊断是癫痫发作、癫痫持续状态和缺血性中风。更常见的并发症，如中风和癫痫发作，以及不太常见的并发症，如 Wernicke 脑病和后部可逆性脑病综合征，应立即进行干预。在会诊的情况下，神经科医师应能够在早期以顾问医师的身份管理神经系统并发症并系统地评估 ICU 患者，并熟悉插管、镇静和有时瘫痪的重症 ICU 患者的复杂性，这些患者的常规临床操作严重受限评价。