Table 1.
Summary of Hourly Neurochecks Across 8,936 Hospitalizations and 9,513 Orders.
| Order duration (days) | ||||
|---|---|---|---|---|
|
|
||||
| Characteristic | n, % | Median (IQR) | Maximum | hospital LOS, median % (IQR)a |
|
| ||||
| Ageb | ||||
| 18 to 64 years old | 5,784 (65%) | 1.10 (0.68, 2.43) | 81 | 31% (16%, 55%) |
| 65 to 79 years old | 1,944 (22%) | 1.28 (0.76, 2.76) | 66 | 32% (17%, 57%) |
| 80 years and older | 1,208 (14%) | 1.14 (0.74, 2.05) | 69 | 30% (17%, 52%) |
| Ordering service | ||||
| Neurocritical care | 1,697 (18%) | 1.54 (0.80, 3.59) | 69 | 33% (17%, 57%) |
| Neurosurgery | 2,071 (22%) | 0.87 (0.65, 1.68) | 65 | 29% (18%, 55%) |
| Trauma | 4,067 (43%) | 1.11 (0.67, 2.08) | 37 | 34% (18%, 54%) |
| Non-neurological ICUc | 639 (7%) | 1.60 (0.83, 2.97) | 81 | 21% (9%, 45%) |
| Non-ICU / other | 1,039 (11%) | 1.08 (0.67, 2.31) | 38 | 28% (12%, 53%) |
| Post-discontinuation orderd | ||||
| Every 2 to 3 hours | 4,251 (45%) | 1.20 (0.71, 2.53) | 65 | 27% (16%, 43%) |
| Every 4 hours | 2,708 (28%) | 1.02 (0.67, 2.24) | 45 | 28% (15%, 46%) |
| Every 6 to 24 hours | 324 (3%) | 1.06 (0.66, 2.18) | 37 | 28% (15%, 50%) |
| No more neurochecks | 2,225 (23%) | 1.03 (0.69, 2.05) | 81 | 63% (26%, 94%) |
| Admission diagnosisb,e | ||||
| Coma and increased ICP | 1,209 (14%) | 1.38 (0.84, 2.73) | 37 | 38% (24%, 57%) |
| Traumatic non-TBI | 1,180 (13%) | 1.06 (0.57, 2.01) | 19 | 24% (12%, 43%) |
| Ischemic stroke | 907 (10%) | 1.45 (0.86, 3.01) | 60 | 36% (21%, 69%) |
| Non-neurological | 846 (9%) | 1.26 (0.66, 2.66) | 81 | 21% (8%, 47%) |
| CNS tumor | 783 (9%) | 0.82 (0.64, 1.56) | 27 | 22% (14%, 34%) |
| Traumatic brain injury | 702 (8%) | 1.12 (0.67, 2.49) | 32 | 37% (24%, 59%) |
| Other Neurologicalf | 320 (4%) | 0.80 (0.61, 1.42) | 38 | 24% (14%, 41%) |
| Elective vascular | 221 (2%) | 0.93 (0.77, 1.13) | 66 | 67% (31%, 83%) |
| Spine and spinal cord injury | 211 (2%) | 1.58 (0.73, 2.85) | 17 | 22% (12%, 38%) |
| Seizure | 164 (2%) | 0.94 (0.61, 1.92) | 15 | 27% (14%, 51%) |
| Intracranial hemorrhage | 152 (2%) | 1.81 (0.88, 4.56) | 22 | 33% (16%, 52%) |
| Subarachnoid hemorrhage | 92 (1%) | 4.68 (1.54, 11.90) | 55 | 56% (31%, 80%) |
| None listed | 2,149 (24%) | 1.16 (0.73, 2.64) | 69 | 37% (19%, 64%) |
| Discharge destinationb | ||||
| Home | 5,190 (58%) | 0.92 (0.64, 1.63) | 81 | 31% (17%, 52%) |
| Non-homeg | 2,881 (32%) | 1.67 (0.86, 3.95) | 69 | 29% (14%, 51%) |
| Died in hospital | 865 (10%) | 2.38 (0.99, 5.02) | 33 | 58% (22%, 91%) |
| Year | ||||
| 2012 | 1,186 (12%) | 1.21 (0.75, 2.74) | 30 | 39% (19%, 69%) |
| 2013 | 1,380 (15%) | 1.05 (0.67, 2.24) | 45 | 32% (17%, 57%) |
| 2014 | 1,522 (16%) | 1.09 (0.65, 2.56) | 46 | 30% (17%, 52%) |
| 2015 | 1,565 (16%) | 1.04 (0.67, 2.28) | 65 | 30% (16%, 52%) |
| 2016 | 1,659 (17%) | 1.10 (0.70, 2.26) | 81 | 29% (16%, 52%) |
| 2017 | 1,807 (19%) | 1.10 (0.69, 2.23) | 69 | 30% (16%, 51%) |
| 2018 | 394 (4%) | 0.95 (0.70, 1.71) | 21 | 29% (18%, 47%) |
| Quarter | ||||
| January to March | 2,577 (27%) | 1.04 (0.68, 2.11) | 69 | 31% (17%, 54%) |
| April to June | 2,210 (23%) | 1.05 (0.66, 2.47) | 81 | 31% (17%, 55%) |
| July to September | 2,366 (25%) | 1.14 (0.72, 2.39) | 45 | 32% (17%, 54%) |
| October to December | 2,360 (25%) | 1.10 (0.68, 2.37) | 38 | 31% (16%, 54%) |
| All hospitalizationsb | 8,936 | 1.13 (0.71, 2.46) | 81 | 31% (17%, 55%) |
| All orders | 9,513 | 1.09 (0.69, 2.35) | 81 | 31% (17%, 54%) |
Abbreviations: CNS, central nervous system; ICP, intracranial pressure; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; TBI, traumatic brain injury.
N = 8,933 (9,510 hourly neurocheck orders) due to missing length of stay data for 3 hospitalizations.
Cumulative neurocheck duration over the entire admission.
Includes pulmonary critical care, anesthesia and cardiology critical care.
N = 9,508 hourly neurocheck orders; 5 assessments (not listed) changed to every 30 minutes.
Based on ICD-10 code; unless otherwise specified, diagnoses are non-traumatic.
Includes, for example, migraine, myasthenia gravis, CNS infection, multiple sclerosis, dementia.
Includes rehabilitation facility, skilled nursing facility, long-term care facility, hospital-to-hospital transfer, jail, against medical advice, psychiatric facility.