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Outcome of Intensive Care management of neurosurgical patients before and after the commencement of neurosurgical service in a resource poor centre: A Nigerian perspective
Abstract
Background: Outcome of intensive care management of neurosurgical patients depends not only on the standard and
effectiveness of the treatment obtained but also on the available technical and human resource. We aimed at evaluating
the impact of a new neurosurgeon-led team on the outcome of neurosurgical patients managed in our multipurpose resource scarce ICU.
Patients and Methods: Demographics, neurological data, length of stay (LOS) and mortality rates (MR) of patients admitted 5 years before (n=22) and five years after (n=159) the commencement of the neurosurgical service were collated and analysed. Outcome was retrospectively compared between the two periods.
Results: Neurosurgical patients (n=181) constituted 24.6% of 735 admissions into the ICU during the ten-year period. The commonest indications for admission were head injury (157, 86.6%), spinal cord injury (9, 5%) and postbrain tumour excision (13, 8.2%). From the first to the second period, the overall MR declined from 77.3% to 47.2%, while MR in head and spinal cord injured patients dropped from 83.3% to 49.6% and 50% to 40% respectively. Among the head injured, outcome was significantly influenced by post-resuscitation GCS (p <0.001) at admission. Contrary to expectation, the mean LOS from admission to discharge and death increased from 5.5 ±4.3SD and 2.1±2.0SD days in the before to 11.1±20.7SD and 3.1±4.6SD in the after-period respectively.
Conclusion: The service of a neurosurgeon-led team was associated with improved outcome among neurosurgical patients requiring intensive care management in our resource poor centre.
Key words: outcome, intensive care, head and spinal cord injury
effectiveness of the treatment obtained but also on the available technical and human resource. We aimed at evaluating
the impact of a new neurosurgeon-led team on the outcome of neurosurgical patients managed in our multipurpose resource scarce ICU.
Patients and Methods: Demographics, neurological data, length of stay (LOS) and mortality rates (MR) of patients admitted 5 years before (n=22) and five years after (n=159) the commencement of the neurosurgical service were collated and analysed. Outcome was retrospectively compared between the two periods.
Results: Neurosurgical patients (n=181) constituted 24.6% of 735 admissions into the ICU during the ten-year period. The commonest indications for admission were head injury (157, 86.6%), spinal cord injury (9, 5%) and postbrain tumour excision (13, 8.2%). From the first to the second period, the overall MR declined from 77.3% to 47.2%, while MR in head and spinal cord injured patients dropped from 83.3% to 49.6% and 50% to 40% respectively. Among the head injured, outcome was significantly influenced by post-resuscitation GCS (p <0.001) at admission. Contrary to expectation, the mean LOS from admission to discharge and death increased from 5.5 ±4.3SD and 2.1±2.0SD days in the before to 11.1±20.7SD and 3.1±4.6SD in the after-period respectively.
Conclusion: The service of a neurosurgeon-led team was associated with improved outcome among neurosurgical patients requiring intensive care management in our resource poor centre.
Key words: outcome, intensive care, head and spinal cord injury
