Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

Acharya, Subhash Prasad; Bhattarai, Binita; Bhattarai, Adheesh; Pradhan, Saurabh; Sharma, Mohan Raj

doi:10.33314/jnhrc.v16i3.1629

Cited by 3 publications

(7 citation statements)

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“…Among the 55 included quantitative studies on stroke patients in Nepal, 19 were cross-sectional studies [ 10 – 28 ], 17 were retrospective [ 29 – 45 ], and 17 were prospective cohort studies [ 46 – 62 ]. Two case-control studies were present [ 63 , 64 ], while no randomized trials were found.…”

Section: Resultsmentioning

confidence: 99%

“…All 55 studies were hospital-based and were conducted in the tertiary health sector. Of the 55 studies in stroke patients, majority (n = 26) were done in Kathmandu valley [ 12 , 13 , 15 , 16 , 19 , 22 , 27 – 29 , 31 , 33 , 34 , 41 – 45 , 49 – 52 , 54 , 55 , 59 , 61 , 64 ], followed by Sunsari (n = 7) [ 18 , 30 , 40 , 53 , 56 , 60 , 63 ], Chitwan (n = 6) [ 21 , 25 , 26 , 47 , 48 , 57 ] and Morang (n = 6) [ 24 , 32 , 36 , 46 , 58 , 62 ], which represent Central and Eastern region of Nepal. Only three studies were done in Nepalgunj, the Mid-western part of Nepal [ 11 , 23 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…From 23 studies investigating aspects of acute care [ 13 , 30 , 40 , 49 ], four studies consisted of data on length of hospital stay [ 13 , 30 , 40 , 49 ], four studies highlighted complications [ 13 , 16 , 30 , 48 ], and 19 studies reported mortality [ 11 , 17 , 21 , 26 , 29 , 30 , 32 , 34 , 36 , 38 , 40 , 41 , 45 , 48 , 51 , 52 , 56 , 57 , 62 ]. 12 studies included treatment modalities [ 21 , 31 , 32 , 36 , 38 , 42 – 45 , 48 , 57 , 61 ] [ 42 , 44 , 61 ].The outcome of stroke was described in 22 studies [ 11 , 17 , 21 , 26 , 29 , 30 , 32 – 34 , 36 , 38 , 40 , 41 , 43 – 45 , 48 , 51 , 52 , 56 , 57 , 62 ], and the long-term outcome (3 months after stroke) was investigated only in seven studie...…”

Section: Resultsmentioning

confidence: 99%

“…Data on stroke care was reported in 12 studies [ 13 , 29 , 30 , 40 , 48 , 49 ], and intravenous thrombolysis (IVT) was used in 2.39% of patients [ 42 , 44 , 61 ], and no studies reported on endovascular thrombectomy (EVT). While no study reported on stroke unit care, the mean length of hospital stay was 6.1 days [ 13 , 30 , 40 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

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Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Paudel,

Tunkl,

Shrestha

et al. 2023

BMC Neurol

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Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Paudel,

Tunkl,

Shrestha

et al. 2023

BMC Neurol

View full text Add to dashboard Cite

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“…Neurotrauma was most common in our study which is similar [7][8][9][10][11][12] to other studies. Mortality in traumatic brain injury patient was 3.22% while in other studies it varied from 10.5% to [13][14][15][16] 30%. 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.…”

Section: Discussionmentioning

confidence: 98%

The Outcome of Trauma Patients in the Mixed Semi-closed Intensive Care Unit

Keyal

Yadav

Singh

et al. 2022

J Univ Coll Med Sci

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INTRODUCTIONNepal due to its geographical condition, inadequate resuscitation on time, and lack of full-time intensivist in a trauma team is a cause of trauma-related morbidity and mortality. MATERIAL AND METHODSIt was a prospective, descriptive observational cross-sectional study in a level three intensive care unit of National Medical College for six month. All patients >18 years with a history of road traffic accidents, falls, drowning, physical assaults, and self-inflicted violence admitted to the mixed intensive care unit of a tertiary care hospital were included in this study. RESULTSOne hundred and ninety-one patients were included in this study. 152(79.5%) were males and 39(20.4%) were females. A road traffic accident was the most common mode of injury in 166(86.9%) patients. 178(93.1%) patients survived and went home, 10(5.3%) expired, 2(1%) left the hospital against medical advice (LAMA) and 1(0.5%) gave do not resuscitate orders (DNR). The mean days on the mechanical ventilator was 3.39±2.57 days. Mortality in an intubated patient was 8.6%. Mean LOS in the ICU was 4.28±4.12 days. SOFA and APACHE II scores were a good predictor of outcome, with the SOFA score being the most effective Injury severity score predicted mortality with a sensitivity of 88.9%, a specificity of 22%, with an AUROC curve of 0.543±0.092 with cut off score of 5.5. CONCLUSIONRaising public awareness, and strictly following the traffic rules can help in reducing the incidence of trauma. Trauma team consisting of full-time intensivists should be established to decrease the mortality in the intensive care unit.

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The ethics of practicing defensive medicine in Jordan: a diagnostic study

Al-Balas

Al‐Balas

2021

BMC Med Ethics

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Background Defensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician’s legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and health systems, patients’ exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences. Methods This work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan. Results This is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician’s efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future. Conclusion Jordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship.

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Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

Cited by 3 publications

References 0 publications

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

The Outcome of Trauma Patients in the Mixed Semi-closed Intensive Care Unit

The ethics of practicing defensive medicine in Jordan: a diagnostic study

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