Opinion paper| Volume 110, P71-73, April 2023

Reassessing hourly neurochecks


      Following acute brain injury, frequent neurological examinations (“neurochecks”) are commonly prescribed and form the cornerstone of many care protocols and guidelines (e.g., for intracranial hemorrhage). While these assessments are intended to identify and mitigate secondary injury, they may unintentionally contribute to additional injury related to neurocheck-associated sleep disruption. Data are lacking to define patterns of neurological decline following acute brain injury, as are data to define the short- and long-term consequences (e.g., neuropsychological sequelae) of frequent and prolonged neurochecks. A critical need exists for rigorous evaluation of neurocheck practices, perceptions, benefits and risks, along with interventions to optimize neurocheck frequency and duration.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kraus J.F.
        • Black M.A.
        • Hessol N.
        • et al.
        The incidence of acute brain injury and serious impairment in a defined population.
        Am J Epidemiol. 1984; 119: 186-201
        • Hemphill J.C.
        • Greenberg S.M.
        • Anderson C.S.
        • et al.
        Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2015; 46: 2032-2060
        • Powers W.J.
        • Rabinstein A.A.
        • Ackerson T.
        • et al.
        Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2019; 50
        • Diringer M.N.
        • Bleck T.P.
        • Claude Hemphill J.
        • et al.
        Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference.
        Neurocrit Care. 2011; 15
        • LaBuzetta J.N.
        • Hirshman B.R.
        • Malhotra A.
        • Owens R.L.
        • Kamdar B.B.
        Practices and patterns of hourly neurochecks: analysis of 8,936 patients with neurological injury.
        J Intensive Care Med. 2022; 37: 784-792
        • Maas M.B.
        • Rosenberg N.F.
        • Kosteva A.R.
        • Bauer R.M.
        • Guth J.C.
        • Liotta E.M.
        • et al.
        Surveillance neuroimaging and neurologic examinations affect care for intracerebral hemorrhage.
        Neurology. 2013; 81: 107-112
        • Lord A.S.
        • Gilmore E.
        • Choi H.A.
        • Mayer S.A.
        • Collaboration V.-I.
        Time course and predictors of neurological deterioration after intracerebral hemorrhage.
        Stroke. 2015; 46: 647-652
        • Stone J.J.
        • Childs S.
        • Smith L.E.
        • Battin M.
        • Papadakos P.J.
        • Huang J.H.
        Hourly neurologic assessments for traumatic brain injury in the ICU.
        Neurol Res. 2014; 36: 164-169
        • Phelan H.A.
        • Richter A.A.
        • Scott W.W.
        • Pruitt J.H.
        • Madden C.J.
        • Rickert K.L.
        • et al.
        Does isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other traumatic brain injury?.
        J Neurotrauma. 2014; 31: 1733-1736
        • Dorsch N.W.C.
        • King M.T.
        A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage Part I: Incidence and effects.
        J Clin Neurosci. 1994; 1: 19-26
        • Xie L.
        • Kang H.
        • Xu Q.
        • Chen M.J.
        • Liao Y.
        • Thiyagarajan M.
        • et al.
        Sleep drives metabolite clearance from the adult brain.
        Science. 2013; 342: 373-377
        • Tononi G.
        • Cirelli C.
        Sleep and the price of plasticity: from synaptic and cellular homeostasis to memory consolidation and integration.
        Neuron. 2014; 81: 12-34
        • Nir Y.
        • Andrillon T.
        • Marmelshtein A.
        • Suthana N.
        • Cirelli C.
        • Tononi G.
        • et al.
        Selective neuronal lapses precede human cognitive lapses following sleep deprivation.
        Nat Med. 2017; 23: 1474-1480
        • Chang V.A.
        • Owens R.L.
        • LaBuzetta J.N.
        Impact of sleep deprivation in the neurological intensive care unit: a narrative review.
        Neurocrit Care. 2020; 32: 596-608
        • LaBuzetta J.N.
        • Malhotra A.
        • Zee P.C.
        • Maas M.B.
        Optimizing sleep and circadian health in the NeuroICU.
        Curr Treat Options Neurol. 2022; 24: 309-325
        • LaBuzetta J.N.
        • Rosand J.
        • Vranceanu A.M.
        Review: Post-intensive care syndrome: unique challenges in the neurointensive care unit.
        Neurocrit Care. 2019; 31: 534-545
        • McLaughlin D.C.
        • Hartjes T.M.
        • Freeman W.D.
        Sleep deprivation in neurointensive care unit patients from serial neurological checks: how much is too much?.
        J Neurosci Nurs. 2018; 50: 205-210
      1. LaBuzetta J.N., Kazer M.R., Kamdar B.B., et al. Neurocheck frequency: determining perceptions and barriers to implementation of evidence-based practice. Neurologist 2022. Epub ahead of print.

        • Maas M.B.
        • Naidech A.M.
        Critical care neurology perspective on delirium.
        Semin Neurol. 2016; 36: 601-606
        • Marra A.
        • Ely E.W.
        • Pandharipande P.P.
        • Patel M.B.
        The ABCDEF bundle in critical care.
        Crit Care Clin. 2017; 33: 225-243
        • Bryant P.
        • Yengo-Kahn A.
        • Smith C.
        • Smith M.
        • Guillamondegui O.
        Decision support tool to judiciously assign high-frequency neurologic examinations in traumatic brain injury.
        J Surg Res. 2022; 280: 557-566
        • De Leon Benedetti A.M.
        • Bhatia R.
        • Ancheta S.R.
        • Romano J.G.
        • Koch S.
        How well do neurochecks perform after stroke?.
        Stroke. 2021; 52: 1094-1097
        • Qureshi A.A.
        • Mulleady V.
        • Patel A.
        • Porter K.M.
        Are we able to comply with the NICE head injury guidelines?.
        Emerg Med J. 2005; 22: 861-862
        • Banzon P.C.
        • Vashisht A.
        • Euckert M.
        • et al.
        Original research: practice variations in documenting neurologic examinations in non-neuroscience ICUs.
        Am J Nurs. 2023; 123: 24-30