{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:18:38Z","timestamp":1777853918840,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T00:00:00Z","timestamp":1744502400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T00:00:00Z","timestamp":1744502400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To study the impact of dedicated Neuroscience Intensive Care Units (NSU) on clinical outcomes in patients with acute brain injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective, multicenter cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>172 intensive care units within the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Prospectively compiled and maintained a registry of a total of 32,047 brain-injured patients (stroke\u2009=\u2009AIS, aneurysmal-bleed\u2009=\u2009SAH, intra-cerebral-hemorrhage\u2009=\u2009ICH, and traumatic brain injury\u2009=\u2009TBI) from 2008\u20132013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Exposure of interest was the type of intensive care unit (ICU), divided into NSU and non-NSU (medical\u2009=\u2009MICU, non-neurosurgical\u2009=\u2009SICU, trauma\u2009=\u2009TICU, cardiac\u2009=\u2009CCU, or mixed). Outcomes of interest were the actual and predicted in-hospital mortality, ICU mortality, ICU length of stay, and ventilator-free days. We calculated the actual and predicted in-hospital mortality using the Cerner Corporation Acute Physiology and Chronic Health Evaluation IV (APACHE Clinical Information System, CIS). We then compared the actual in-hospital mortality against the mortality prediction of the APACHE-IV model based on ICU designation (NSU v. non-NSU). The multivariable model was adjusted for within-hospital effects and known predictors of poor outcomes after brain injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>National APACHE-IV predicted that in-hospital mortality was higher for NSU admissions than non-NSU admissions (21% v. 19%, p\u2009&lt;\u2009.0001). However, the actual ICU mortality (10% vs 11%, p\u2009&lt;\u20090.01) and in-hospital mortality (15% vs 16%, p\u2009=\u20090.06) were lower in patients admitted to a NSU as compared to non-NSU. We observed lower ventilator-free days (22 vs 24, p\u2009&lt;\u20090.001) in NSU v. non-NSU. In the multivariable regression analysis adjusted for within-hospital effects, known variables of poor outcome, and the severity of illness APACHE-III score, the in-hospital mortality was lower for NSU admissions (OR, 0.8; 95%CI, 0.7-0.9, p\u2009=\u20090.02) as compared to non-NSU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Admission of critically ill brain-injured patients to dedicated NSUs is associated with lower actual in-hospital mortality. Future iterations of APACHE-IV modeling may need to incorporate NSU designations for calculations of expected mortality among brain-injured patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666251325778","type":"journal-article","created":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T11:43:41Z","timestamp":1744544621000},"page":"902-906","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["In-hospital Mortality is Lower in Brain-Injured Patients After Admission to a Neuroscience Intensive Care Unit: A Multi-Center Cohort Study"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2126-6519","authenticated-orcid":false,"given":"Angel J.","family":"Cadena-Tejada","sequence":"first","affiliation":[{"name":"University of Texas Health Science at Houston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaista","family":"Alam","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varoon","family":"Thavapalan","sequence":"additional","affiliation":[{"name":"Aurora Health Care, Milwaukee, WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Habib","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8510-118X","authenticated-orcid":false,"given":"Fred","family":"Rincon","sequence":"additional","affiliation":[{"name":"Cooper University Hospital, Camden, NJ, 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