A review of neurosurgical admissions in a Nigerian Intensive Care Unit

Context: Neurosurgical patients following surgery or trauma are often monitored in an intensive care setting for a period of time. Studies with a comprehensive and predictive model of factors contributing to Intensive Care Unit (ICU) outcome following neurosurgical admissions are few in our environment. Aims: The aim of the study was to document the pattern of neurosurgical ICU admissions and predictors of outcome in our center for improved resource allocation and overall reduction in a poor outcome. Settings and Design: A retrospective study was conducted on adult patients admitted to ICU in 2015 with neurosurgical diagnosis. Subjects and Methods: Patient demographics, admission characteristics, details of neurosurgical diagnosis, ICU interventions, and outcome were obtained from the ICU record. Statistical Analysis Used: Data were analyzed with SPSS version 20. Results: Of 286 patients admitted in the study year, 95 (33.2%) followed neurosurgical indications. Twelve patients below 16 years were excluded leaving 83 adults in the review. Admissions following traumatic brain injury and intracranial tumor surgery each accounted for 35%. Although poorer outcome was observed in the traumatic brain injury, traumatic myelopathy, and clot evacuation groups, the difference was not statistically significant (P 0.34). Forty-two (50.6%) and 28 (34%) patients had ventilatory and vasopressor therapy, respectively. Only Modified Early Warning Score (MEWS) on admission predicted poor outcome (P = 0.04, β =1.63). Conclusions: Traumatic brain injury and intracranial tumor surgery were the main neurosurgical indications for ICU admission. A higher MEWS and lower Glasgow Coma Score on admission were observed among nonsurvivors, but only MEWS on admission predicted poor outcome.