Objective:

To evaluate whether neurointensivist-managed intensive care units (Neuro-ICUs) improve mortality, functional outcomes, and length of stay compared with non-neuro (Medical/Surgical) ICUs in adults with acute neurological conditions.

Background:

Neurocritical care has expanded rapidly, driven by the hypothesis that specialized expertise improves outcomes in critically ill neurological patients. However, comprehensive synthesis across populations and healthcare systems is needed to inform practice and policy.

Design/Methods:

We conducted a PRISMA-guided systematic review and meta-analysis of MEDLINE, Embase, Cochrane Central, and Web of Science for all studies published prior to August, 2025. Eligible studies compared Neuro-ICU outcomes with Medical and Surgical ICU outcomes in adults with traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, or mixed neurological populations. Inclusion criteria required dedicated neurointensivist involvement and reporting of mortality or functional outcomes. Two reviewers independently extracted data and assessed quality using the Newcastle-Ottawa Scale. Random-effects models generated pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Primary outcomes were mortality and functional recovery; secondary outcomes included length of stay and patient satisfaction.

Results:

Eleven studies including 11,673 patients from three countries met inclusion criteria. Neurointensivist-managed care was associated with significantly lower mortality than general ICU care (pooled OR 0.65, 95% CI 0.53–0.80, p<0.001), representing a 35% relative reduction in death odds. Hospital length of stay was reduced by 1.2 days (95% CI –1.8 to –0.6, p<0.001). Heterogeneity was low for mortality (I²=24%). Subgroup analyses showed consistent benefits across neurological populations, with the strongest effect in subarachnoid hemorrhage. Patient satisfaction improved by 67.5%, and no publication bias was detected.

Conclusions:

Neurointensivist-managed care is associated with reduced mortality and shorter hospital stays compared with general ICU management for acute neurological conditions. These findings support the development of specialized neurocritical care services with dedicated neurointensivist staffing, particularly for subarachnoid hemorrhage and other complex neurological emergencies.