To determine the impact of post-intensive care syndrome (PICS) on quality of life (QOL) for critically ill stroke patients admitted to a neurocritical care unit (NCCU).  

PICS has been defined in survivors of critical care by new or worsening impairments in functional ability, cognition, or mental health. Studies of PICS have excluded patients with brain injuries. Therefore, there is a dearth of data on the incidence and impact of PICS after neurocritical care (N-PICS). In this study, we included stroke patients admitted to an NCCU and hypothesized N-PICS would result in lower QOL as compared to those without N-PICS. 

Retrospective analysis of longitudinal quality-improvement data for NCCU patients admitted over a four-year period.  Phone interviews after discharge collected outcome measures of cognitive function, mental health, and functional status via Telephone Interview for Cognitive Status (TICS), modified Euro-QOL 5D, and modified Rankin Score (mRS) or Glasgow Outcome Scale-Extended (GOS-E) respectively. N-PICS was defined as impairment in at least one domain. 

1101 patients admitted with acute stroke were analyzed. Mean age was 59.8±14.6 years; 192 (48%) were women. At follow-up of 4.4±0.8 months, 446/1101 (40.5%) had died. Of survivors, n=372 (57%) were reached by phone with >1 outcome domain captured, 65.6% of whom met criteria for N-PICS with disability in one (34.9%) or more (30.6%) domains. The median QOL scores were significantly lower in patients with N-PICS: impairments in 2-3 domains median QOL score was 50 (IQR 31-60)  and impairments in 1 domain median score was 60 (IQR 46-75)  as compared to no impairments (median 80, IQR 70-90) (H=99.5, p<0.001).

N-PICS is prevalent in two-thirds of stroke patients admitted to NCCUs with impairments in at least one domain. 40% of these patients had impairment in mental health or cognition alone. Those with N-PICS had a lower QOL compared to those without N-PICS.