Outcome of management of neurosurgical patients in the intensive care unit: An early clinical audit of a single institution from a developing country

Care of neurosurgical patients in the Intensive Care Unit (ICU) has been evolving in recent times. This included fast growing new techniques in neuromonitoring, neuroimaging and enhanced therapeutic tools. The pace of evolution has not been replicated in resource-constrained setting such as in Nigeria, despite overwhelming evidence of its benefit to neurological patients. Patients’ outcome, including death, in the ICU is a reflection of quality of care assessed during the hospitalization process; as many neurosurgical patients require ICU bed in the course of hospital care. The objective was to characterize the profile of the patients, mortality and factors associated with mortality while in the ICU at the dawn of commencement of neurosurgical services at our centre. A descriptive retrospective study utilizing patients’ datasets of all neurosurgical admissions into the ICU of a tertiary hospital, University of Abuja Teaching Hospital, Abuja, between 2013 and 2015 were analyzed for deaths and factors associated to death. During the 3-years period, 19 neurosurgical deaths occurred in the ICU of University of Abuja Teaching Hospital, translating to a mortality of 63.3%. The majority of the deceased patients (n=22, 71%), was of the young age group and died from head trauma. 14 (73.7%) presented late to the hospital, and all the deceased presented late to the ICU. 17 (89.5%) had head injury, of which, 84.2% was from severe head injury. All the deceased who were administered mannitol died. The early data suggest an unusually high mortality among neurosurgical patients managed in the ICU. A reflected application of modern intensive care measures might lead to increased survival of neurocritically ill patients.