ABSTRACT
Senegal, like many African countries is facing the so-called demographic and epidemiological transition leading to the development of neurological diseases. These diseases dominated by stroke and status epilepticus are public health priorities with a high prevalence, high lethality and high cost of care. These diseases are managed at the department of neurology, Fann Teaching Hospital, Dakar-Senegal (the only one) with a 65 beds capacity. Unfortunately, access care to the clinic is lately associated with human and material resource scarcity. To improve the management of patients at the clinic, it is important to increase resources (human and material), sensitize the population on early access to health services and prevention of risk factors.
Subject(s)
Emergency Medical Services/organization & administration , Nervous System Diseases/therapy , Brain Injuries/complications , Brain Injuries/therapy , Coma/etiology , Coma/therapy , Demography , Developing Countries , Humans , Paralysis/therapy , Seizures/therapy , Senegal , Stroke/therapyABSTRACT
Little is known on coma in neurological intensive care unit (NICU) in the setting of developing country in Sub-Saharan Africa. The aim of this study was to determine the morbi-mortality and survival of coma in the NICU of Dakar, Senegal. We carried out a prospective longitudinal study in the NICU of the teaching hospital of Fann in Dakar during a period of 15 months (with 12 months of inclusion) on comatose patients. Were included all patients presenting with a Glasgow score inferior to 9. Standard biological analyses were prescribed for each patient while CT scan was performed if indicated. Daily evaluation was done and complications recorded. Each patient was followed for at least 3 months. Survival was determined by the Kaplan Meier method. 345 patients were admitted in the NICU and 169 were included (48,99 %). The mean age of the patients was 58.04 +/- 17.55 years with a sex ration of 0.92. The mean time from installation of disorders and initial consultation was 47.30 +/- 138.34 hours. Etiologies were vascular disease (71 %), status epilepticus (9.47 %), meningoencephalitis (8.88 %) and metabolic disorders (8.88 %). The mean duration of hospitalization was 8.89 +/- 9.53 days associated with a mortality rate of 82.25 % for the same period. Survival at day 90 was 10.65 %. Mortality was related to infectious condition (28.4 %), renal failure (14.78 %), cardiovascular failure (13.61 %), cerebral engagement (12.43 %), multivisceral failure (11.24 %), pulmonary embolism (1.18 %) and unknown cause (18.34 %). In conclusion, coma is associated with a high mortality rate in our context and suggests that early consultation, a good control of vascular risk factors and better management of infectious condition should reduce this impact.
Subject(s)
Coma/mortality , Adult , Aged , Aged, 80 and over , Coma/etiology , Female , Glasgow Coma Scale , Humans , Intensive Care Units , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Senegal/epidemiologyABSTRACT
BACKGROUND: In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal. METHODS: This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded. RESULTS: A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9). CONCLUSION: Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.
Subject(s)
Coma/mortality , Stroke/mortality , Aged , Brain Ischemia/complications , Brain Ischemia/mortality , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/mortality , Coma/etiology , Coma/therapy , Female , Glasgow Coma Scale , Hospital Departments/statistics & numerical data , Humans , Intensive Care Units , Longitudinal Studies , Male , Middle Aged , Prognosis , Prospective Studies , Senegal/epidemiology , Socioeconomic Factors , Stroke/etiology , Stroke/therapy , Survival , Survival Analysis , Tomography, X-Ray ComputedABSTRACT
Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.
Subject(s)
Cerebral Hemorrhage/mortality , Coma/mortality , Adult , Aged , Aged, 80 and over , Critical Care , Female , Hospital Mortality , Humans , Longitudinal Studies , Male , Middle Aged , Prognosis , Prospective Studies , Senegal/epidemiology , Survival AnalysisABSTRACT
Trente cinq pour cent des accidents vasculaires cerebraux sont de nature hemorragique a Dakar. Le coma constitue souvent un mode de revelation de la maladie et un facteur de gravite. En l'absence de therapeutique specifique en Afrique subsaharienne; seul un traitement medical symptomatique est propose en general aux patients victimes d'hemorragie cerebrale. Le but de l'etude etait d'etudier la survie et d'evaluer le pronostic des hemorragies cerebrales avec coma dans une unite de neuroreanimation senegalaise. Il s'agissait d'une etude longitudinale qui s'etait deroulee du 15 avril 2006 au 18 juillet 2007 a l'unite de neuroreanimation du Centre Hospitalier Universitaire de Fann a Dakar. Les taux de mortalite et la probabilite de survie etaient estimes par la methode de Kaplan Meier. L'effet des variables significativement associees au pronostic etait etudie en analyse multivariee a l'aide d'un modele des risques proportionnels de Cox. Cinquante et un cas d'hemorragie intracerebrale etaient inclus avec une mediane d'age de 64 ans et un sex ratio de 1;13. La mediane de survie etait de 7 jours et la mortalite en neuroreanimation etait de 80;4. Les probabilites de survie a J10; J30 et J90 etaient respectivement de 43;14; 21;57et 13;73. L'existence de complications a J3 etait apparue comme facteur independant de mortalite precoce. Les hemorragies intracerebrales avec coma sont associees a une mortalite elevee et soulignent l'interet de la prevention primaire
