Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

T. Rabiu, I. Uthman, E. O. Folami
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Abstract

Background: Neurosurgical patients are the most critical ICU admissions. While advancements in neurosurgical ICUs (NICU) have improved outcomes of care globally, ICU mortality remains a major clinical issue in developing nations. This study evaluates ICU mortalities of neurosurgical patients in a general ICU setting at the UNIOSUN Teaching Hospital, Osogbo, Nigeria. Method: Case records of neurosurgery patients who died in the ICU of UNIOSUN Teaching Hospital, Osogbo, South-Western, Nigeria from June 2012 to  May 2022 were reviewed. Simple descriptive statistics of data on demographics, clinical diagnoses, management and outcome were done. Results: Mortality rate was 38.9% (84 of 216 admissions). Males were 67(79.8%) and the mean age was 41.5years (Range: 2-85years). The average  duration of ICU stay was 3.5days (Range: 30minutes-20days). Most patients had severe traumatic brain injury (TBI) (62, 73.8%). This was followed by  cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). Two had brain abscess. One patient each had mixed subacute/chronic subdural  haematoma and severe cervical spondylotic myelopathy. Of the 69 whose case files were found, 7(10.1%) had a diagnosis of brainstem death before  eventual 'final' death after an average of 13.5 additional hours on mechanical life support. The identified secondary causes of death included raised ICP,  sepsis, primary surgical haemorrhage, seizures, acute kidney injury, malignant hypertension, poor glycaemic control and aggressive blood pressure  lowering. Only 1 patient had autopsy. Conclusion: Most ICU mortalities among neurosurgical patients were from severe TBI. The establishment of NICU  is necessary to improve outcome of care of neurosurgical patients.  
尼日利亚西南部一家三级医院重症监护病房神经外科病人的死亡情况
背景:神经外科患者是ICU住院患者中最关键的。虽然神经外科ICU (NICU)的进步改善了全球的护理结果,但ICU死亡率仍然是发展中国家的一个主要临床问题。本研究评估了尼日利亚奥索博UNIOSUN教学医院普通ICU环境中神经外科患者的死亡率。方法:回顾2012年6月至2022年5月在尼日利亚西南部奥索博市UNIOSUN教学医院ICU死亡的神经外科患者的病例记录。对人口统计学、临床诊断、治疗和转归进行简单的描述性统计。结果:死亡率为38.9%(216例入院84例)。男性67岁(79.8%),平均年龄41.5岁(范围2 ~ 85岁)。平均ICU住院时间3.5天(范围:30min ~ 20d)。重型创伤性脑损伤(TBI)患者最多(62例,73.8%)。其次是脑血管疾病(12.14.3%)和脑肿瘤(6.7.1%)。2例脑脓肿。1例患者分别有亚急性/慢性硬膜下血肿和严重的脊髓型颈椎病。在发现的69例病例档案中,7例(10.1%)在机械生命支持平均增加13.5小时后最终“最终”死亡前被诊断为脑干死亡。确定的继发性死亡原因包括颅内压升高、败血症、原发性手术出血、癫痫发作、急性肾损伤、恶性高血压、血糖控制不良和积极降低血压。只有1例患者进行了尸检。结论:重症创伤性脑损伤是神经外科患者ICU死亡的主要原因。新生儿重症监护病房的建立是提高神经外科患者护理效果的必要条件。
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