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