What are the indications for admission to a neuro intensive care unit (neuro ICU)?

From the Guidelines

Patients should be admitted to a neuro intensive care unit (neuro ICU) when they have acute, severe neurological conditions requiring specialized monitoring and care, as indicated by the most recent and highest quality study 1. The indications for admission to a neuro ICU include:

• Severe traumatic brain injury (Glasgow Coma Scale score <9)
• Large ischemic strokes with significant edema or mass effect
• Intracerebral hemorrhage with ventricular extension or midline shift
• Subarachnoid hemorrhage (especially Hunt-Hess grades 3-5)
• Status epilepticus requiring continuous EEG monitoring and anesthetic infusions
• Neuromuscular disorders with respiratory compromise (like Guillain-Barré syndrome or myasthenic crisis)
• Post-operative craniotomy patients with complex needs
• Spinal cord injuries with respiratory or hemodynamic instability
• Refractory status epilepticus
• Severe dysautonomia and respiratory compromise
• Autoimmune encephalitis with severe symptoms, such as brainstem involvement or associated hypoventilation 1.

Neuro ICUs provide specialized neurological monitoring, including:

• Intracranial pressure monitoring
• Continuous EEG
• Frequent neurological assessments
• Management of neurocritical care medications The benefit of neuro ICU admission stems from the presence of specialized staff trained in recognizing subtle neurological changes and managing complex neurological emergencies, which can significantly improve outcomes by allowing for rapid intervention when neurological deterioration occurs 1. The primary goal of neuro ICU admission is to provide cardiorespiratory stability and facilitate accurate neurological prognostication, as recommended by the consensus statement from stakeholder professional organizations 1.

From the Research

Indications for Admission to a Neuro Intensive Care Unit (Neuro ICU)

The decision to admit a patient to a neuro ICU is based on several factors, including the severity of their condition, the need for close monitoring, and the potential for rapid deterioration. Some of the indications for admission to a neuro ICU include:

• Traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score of 3-12 2, 3, 4
• Intracranial hemorrhage or other types of intracranial pathology 3
• Acute ischemic or hemorrhagic stroke 5
• Status epilepticus or other severe seizure disorders
• Meningitis or encephalitis
• Acute spinal cord injury
• Other conditions that require close neurologic monitoring and intensive care

Specific Conditions Requiring Neuro ICU Admission

Certain conditions require immediate admission to a neuro ICU, including:

• Severe TBI with a GCS score of 3-5 2
• Traumatic intracranial hemorrhage with a GCS score of 15 3
• Acute subarachnoid hemorrhage
• Status epilepticus or other severe seizure disorders
• Meningitis or encephalitis with signs of increased intracranial pressure or cerebral herniation

Factors Associated with Adverse Outcomes

Several factors are associated with adverse outcomes in patients with traumatic brain injury, including:

• Age 3
• Headache 3
• Subarachnoid hemorrhage 3
• Low GCS score 2, 3, 4
• Presence of shock or hypotension 2, 4
• Need for cardiopulmonary resuscitation 6

Limitations of the Glasgow Coma Scale

The GCS has limitations in predicting outcome in patients with traumatic brain injury, particularly in children 6 and patients without traumatic brain injury 5. The GCS score should be used in conjunction with other clinical factors and imaging studies to determine the need for neuro ICU admission.