Factors affecting Mortality in Neurosurgical ICU of Manipal Teaching Hospital, Pokhara, Nepal

Abstract

Introduction: Mortality is an important self-assessment tool in medical practice. This study assesses various factors associated with mortality in Neurosurgery ICU (NS-ICU).
 Methods: A prospective, cross-sectional study was carried out from January 2017 to December 2017 in 416 patients admitted to NS-ICU. The age, sex, diagnosis, GCS, pupil’s abnormality, vital parameters, laboratory parameters, comorbidities were compared in between mortality and survival group. The individual component of GCS was further evaluated.
 Results: Out of 416 patients, 374 (89.90%) patients were in survival group and 42 (10.10%) patients in mortality group. Trauma 188(45.20%) and Cerebrovascular accident 133(31.97%) were commonest diagnosis on admission. The GCS, eye-opening and motor component of GCS, abnormal pupils, hypertension (HTN), diabetes mellitus (DM), diastolic blood pressure (DBP), heart rate (HR), operated cases and serum urea levels were found to have significant difference between mortality and survival group. These parameters were further subjected to binary logistic regression which showed DBP (B-0.01, p=0.00), HR (B0.02, p=0.00), motor score of GCS (B-0.50, p=0.04), operated cases (B 1.13,p=0.00), abnormal pupils (B1.85,p=0.00), DM (B1.56, p=0.00) to have significant association with mortality.
 Conclusions: High heart rate, low diastolic BP, low motor score of Glasgow Coma Scale, abnormal pupils, diabetes mellitus and operated cases were found to be significantly associated with mortality.

A Prospective Study on the Outcome of Semi-Closed Neurointensive Care in A Tertiary Care Hospital Located in A Rural Area of Eastern Nepal: A Lower-Income Developing Country

“…[10][11][12][13][14] Mortality in neurosurgical patients was 6.4% while in other studies it varied from 10.5-40%. 11,[19][20][21] In present study, LAMA in neurosurgical patients was 1.4% while in a study by Acharya et al 21 it was 7.03%. In our study, DNR in neurosurgical patients was 0.7% while in a study by Acharya et al 21 it was 4.5%.…”

“…The present study has shown that cerebrovascular disease was the most common reason for admission of patients in the ICU which is similar to other studies. [18][19][20] This may be because the cerebrovascular disease is an emergency requiring ICU care while other diseases may present as a non-emergency condition.…”

“…Mortality in the intubated patients was 19% while in other studies varied from 25 to 40%. [10][11][12][13][14][19][20][21] This difference may be due to the co-management of patients by neurointensivist in our study.…”

“…Mortality in TBI was 4.3% while in other studies it varied from 10.5% to 30%. [19][20][21][22] This difference may be due to early intervention by a neurosurgeon, the presence of neurointensivist, different geographical conditions, and a small group of trauma patients in our study. Male (71.7%) was more common than females (28.2%) in this study which is similar to other studies.…”

“…Male (71.7%) was more common than females (28.2%) in this study which is similar to other studies. [10][11][12][13][14][19][20][21] The limitations of our study are primarily related to small sample size. Glasgow outcome scale was not recorded so long term of a patient was not known.…”