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

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

Comparing the Prognosticative Value of APACHE II and mSOFA Scores in Critically Ill Patients: A Prospective Study

Objective: Several predictive scoring systems measuring disease severity are used to predict outcomes, typically mortality, of critically ill patients in the intensive care unit (ICU). Two common validated predictive scoring systems include acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment score (mSOFA). To compare performance of APACHE II and mSOFA score in critically ill patients regarding the outcomes in the form of morbidity and mortality in ICU. Methods: This prospective observational clinical study was conducted on 100 patients over 6 months. For each patient, APACHE II score on day of admission and serial mSOFA scores on day 0, 3, 7 and 10 were calculated and compared. Results: The age of the non-survivors was significantly older than survivors was (57.1±11.76 and 54.28±15.16). [In our study we found that the mean length of ICU stay of non-survivors was (5.41±4.81) & survivors(8.63± 4.81) days.] In our study mortality rate was 40%.The APACHE II score with cut-off point of 23 demonstrated a sensitivity rate of 98.33% & specificity rate of 17.5%, accuracy of 66.00%. Serial mSOFA scores with cut-off of 11 on day0, day3, day7 better differentiated survivors from non-survivors with 98.3% sensitivity, 27.5% specificity and 70% accuracy. Conclusion: Both APACHE II and mSOFA scores can help ICU physicians as a significant predictive marker for mortality in critically ill patients. The serial measurement of mSOFA score in the first week is a better mortality predictor tool than APACHE II score in critically ill patients.

Influencia en la mortalidad según tiempo de ingreso en Unidad de Cuidados Intensivos: experiencia en el Hospital Clínico Regional Valdivia / Mortality according to time of admission to intenit: Hospital Clínico Regional Valdivia experiencesive care un

Introducción: La estructura organizacional de las Unidades de Cuidados Intensivos está basada en turnos, con cambios en los equipos durante la noche y los fines de semana-festivos (FdS-F). Se ha descrito una mayor mortalidad en los ingresos realizados durante estos períodos. Nuestro objetivo es evaluar si la mortalidad de los pacientes ingresados a nuestra unidad se ve influenciada porel horario nocturno o los FdS-F. Metodología: Estudio retrospectivo de la cohorte de pacientes ingresados desde el 1 de enero al 31 de diciembre de 2011 en el Hospital Clínico Regional Valdivia. Se consideró turno día (TD)el comprendido entre las 08:00 AM y las 20:59 PM, y el turno noche (TN) entre las 21:00 y las 07:59 horas. Se asignó como horario de fin de semana al comprendido entre el día viernes a las21:00 horas y el lunes a las 07:59. Dentro de esta misma categoría se incluyeron los festivos, con el mismo rango horario descrito. Base de datos en Excel MAC y análisis estadístico con Vassar Stats. Resultados: Durante el año 2011, se produjeron 425 ingresos, con una mortalidad global de 25 por ciento, variando según el tipo de patología que motivó el ingreso a la unidad (sepsis 45 por ciento, cardiovascular 17 por ciento, respiratorio 30 por ciento, neurológico 26 por ciento, trauma 24 por ciento, digestivo 32 por ciento, renal 14 por ciento, otras 18 por ciento). Los principales motivos de ingreso fueron las patologías cardiovasculares (32 por ciento), sepsis (18 por ciento) y enfermedades respiratorias (14 por ciento). El 51 por ciento requirió de Ventilación Mecánica Invasiva. El tiempo de estadía fue una mediana de 3 días (0-80). El 48 por ciento de los pacientes ingresó en el horario de TD, 38 por ciento en TN, sin contar con la hora de ingreso en el 14 por ciento de los casos. La mortalidad de los pacientes ingresados en TN fue 30 por ciento y los ingresados en TD 25 por ciento (OR 1,29 IC 95 por ciento 0,8126-2,0393; p= 0,29)...

Introduction: The job in most of Intensive Care Units (ICU) is organized in shift work, this system includes the activities performed during nights and weekends or holidays (W-HD). Higher mortality has been described in patients admitted at nights and W-HD. We decided to study if mortality in our unit was related to the admission during these periods. Methods: We reviewed the clinical records of patients admitted at the ICU of Valdivia Hospital since January 31, 2011 to December 31, 2011. Day shift (DS) was defined between 8:00 and 20:59 hours, night shift (NS) between 21:00 and 7:59 hours, weekend was considered as the period between Friday at 21:00hours and Monday at 7:59 and finally, holiday was considered as the period between the previous date at 21:00 and next day at 7:59 hours of a non-laboral day. Data were analyzed with Microsoft EXCEL for Mac and Vassar stats software. Results: four hundred twenty five patients were admitted at the ICU during this period, the mortality was 25 percent. It was different according with type of disease (sepsis 45 percent, cardiovascular disease 17 percent, respiratory disease 30 percent, neurologic disease 26 percent, trauma 24 percent, gastrointestinal disease 32 percent, renal disease 14 percent, others 18 percent). The most frequent causes of admission were cardiovascular diseases (32 percent), sepsis (19 percent) and respiratory diseases (14 percent). 51 percent of patients were submitted to mechanical ventilation. The median of staying in the unit was 3 days (0-80 days). 48 percent of patients were entered at the unit at DS, 38 percent at NS and in 14 percent of cases the time of admission was not registered. Mortality of patients admitted was 30 percent in NS and 25 percent in DS (OR 1,29 CI 95 percent 0,8126-2,0393; p=0,29)...