Clinical Decision Support System for Early Mobilization in the Neuro-ICU

Implementation and Feasibility of a Clinical Decision Support System for Early Mobilization in the Intensive Care Unit

This study aims to evaluate the feasibility, safety, and user acceptability of a tablet- and smartphone-based Clinical Decision Support System (CDSS) designed to guide early mobilization for patients with severe neurological conditions in the intensive care unit (ICU). The CDSS standardizes safety screening across neurological, physiological, and device-related domains and provides graded mobility recommendations from Level 0 (passive range of motion) to Level 10 (independent ambulation).

The single-center, single-arm feasibility study will be conducted over six months in neurosurgical and trauma ICUs. Adult patients (≥18 years) with traumatic brain injury, intracerebral hemorrhage, subarachnoid hemorrhage, or acute ischemic stroke will be included. Primary outcomes include protocol adherence, data completeness, and user satisfaction (System Usability Scale). Secondary outcomes include time to first mobilization, maximum mobility level achieved, and adverse event incidence.

Inclusion Criteria:

• Adults (≥18 years) admitted to the neuro-ICU or trauma ICU.
• Diagnosis of acute neurological conditions, including traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or acute ischemic stroke (AIS).
• Hemodynamically stable and deemed eligible for rehabilitation evaluation.
• Expected ICU stay ≥48 hours.

Exclusion Criteria:

• Pre-existing severe physical disability (modified Rankin Scale ≥4 before admission).
• Unstable intracranial pressure or craniectomy with active cerebrospinal fluid leakage.
• Unstable fractures or contraindications for mobilization as determined by the attending physician.
• Palliative care status or do-not-resuscitate (DNR) orders.
• Patients unable to participate in mobilization assessment due to medical instability or family refusal.