Clinical evolution and survival of neurocritical patients

Cohort with hospitalized patients in follow-up treatment in public and private hospitals between September 2012 and June 2016. Data were initially analyzed from descriptive and inferential statistics. The Kaplan-Meier indicator was applied as a form of survival analysis. The Cox proportional hazards regression model was used to analyze the prognostic factors by calculating the hazard ratio.

Results

Participation of 1,289 patients in the study. Patients with a higher score on the Glasgow Coma Scale presented greater survival, and the one-point increase in the scale score corresponded to 42% improvement in their survival. In the analysis of survival, sex and the use of vasoactive drugs showed a significant difference.

Conclusion

Female patients with a better score on the Glasgow Coma Scale and using vasoactive drugs had higher survival rates.

Critical Care; Glasgow Coma Scale; Critical Care Nursing; Clinical Evolution

	Mean	SD	CI95%
Mean age	42.9	21.6	41.7	44.1
GCS	4	1.6	4.2	4.4
Days of hospitalization	5.1	26.0	3.5	6.7

	N	%	CI95%

Sex
Female	389	31.4	28.8	33.9
Male	852	68.7	66.1	71.2
Cause of hospitalization
Neurological causes	608	54.5	51.6	57.4
External causes	508	45.5	42.6	48.4
Type of hospital
Public	1,226	95.6	94.5	96.8
Private	56	4.4	3.2	5.5
Patient’s outcome
Clinical improvement	651	50.7	48.0	53.4
Death	633	49.3	46.6	52.0
Used sedation
No	954	74.1	71.7	76.5
Yes	334	25.9	23.5	28.3
Type of sedation
Midazolam	20	14.8	8.7	20.9
Phenobarbital	1	0.7	-0.7	2.2
Fentanyl + Midazolam	91	67.4	59.4	75.4
Fentanyl	23	17.0	10.6	23.5
Use of VAD
No	767	64.5	61.7	67.2
Yes	423	35.6	32.8	38.3

	Crude HR	p-value	CI95%		adjusted HR	p-value	CI95%
Sex
Male	1.41	0.002	1.13	1.77	1.16	0.297	0.88	1.54
Female	1.00				1.00
Age	1.00	0.232	1.00	1.01
Diagnosis
External causes	1.20	0.097	0.97	1.48	0.92	0.508	0.72	1.18
Neurological	1.00				1.00
GCS	1.40	0.000	1.31	1.49	1.42	0.000	1.32	1.52
Hospital
Private	0.53	0.040	0.29	0.97	0.53	0.066	0.27	1.04
Public	1.00				1.00

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Palloma Lopes de Arruda. Rua Alexandrino Boa Ventura, 104, Sol Poente CEP 55036-525 – Curuaru, PE, Brazil palloma-lopes@hotmail.com

Brasil

Brasil

Clinical evolution and survival of neurocritical patients * * Extracted from the undergraduate monograph: “Evolução clínica e sobrevida de pacientes neurocríticos”, Nursing Graduação em Enfermagem, Universidade de Pernambuco, 2017.

ABSTRACT

Objective

Method

Results

Conclusion

Clinical evolution and survival of neurocritical patients ^* * Extracted from the undergraduate monograph: “Evolução clínica e sobrevida de pacientes neurocríticos”, Nursing Graduação em Enfermagem, Universidade de Pernambuco, 2017.