STROKE: CRITICAL APPRAISSAL OF INTENSIVE CARE MANAGEMENT.

BACKGROUND: Stroke is a common medical condition in the medical units. Stroke patients are usually managed on the medical wards while some that needs organ support are admitted into the intensive care unit. However there is conflicting data on the benefits or otherwise of admitting stroke patients into the intensive care unit. This necessitated this study to know how much benefit is derived from admitting stroke patients into the intensive care unit. AIM AND OBJECTIVE: The study aims at the benefits of admitting stroke patients into the intensive care unit. The objective included studying the prognostic factors that determines the outcome of stroke patients admitted into the intensive care unit. METHODOLOGY: The case files of all patients admitted and managed in the intensive care unit of LAUTECH teaching hospital between 2002 and 2014 were retrieved and were analysed. The factors used in analyzing included the type of stroke, the age of the patients, the Glasgow Coma scale at admission, the need for intubation and mechanical ventilation as well as the percentage mortality in each subsets. RESULTS: A total of 48 patients were admitted over the study period of which 19 were males and 29 were females. The percentage mortality in females was 78.95 while mortality in males was 62.5%. The higher the age the worse the prognosis, the higher the GCS the better the prognosis. Patients that were intubated and ventilated had percentage mortality of 68.8% and better than non ventilated patients. The hemorrhagic strokes also carries worse prognosis. CONCLUSION: The admission of stroke patients to the intensive care unit should be individualized considering the above mentioned prognostic factors. However patients that are likely to benefit from intensive care unit should be admitted early for them to derive the maximum benefits.

Surgical vs general practitioner assessment: diagnostic accuracy in 2-week-wait colorectal cancer referrals.

AIM: It has been recommended that patients with suspected colorectal cancer should proceed straight to an endoscopic test to increase speed of diagnosis, using only the information in the general practitioner's referral letter. This study aims to establish whether the diagnostic accuracy of the first surgical outpatient assessment is significantly greater than the general practitioner's assessment and if so by what means. METHOD: Demographic variables, symptoms and signs were collected from the first surgical outpatient assessment letters and the general practitioners' referral letters in 2-week-wait colorectal cancer referrals made between 2002 and 2005. Multiple logistic regression models derived from both the surgeons' and the general practitioners' letters were compared with receiver operator characteristic curves. RESULTS: Variables were collected from 978 2-week-wait colorectal cancer referrals. The median age was 69 years (range 19-98) and the male to female ratio was 1:2. Seventy-eight referrals were diagnosed with colorectal cancer. Surgeons' models demonstrated significantly greater diagnostic accuracy than general practitioners' models (area under the curve, 0.84 vs 0.73; P < 0.003). General practitioners' letters contained significantly less information than surgeons' letters (P < 0.001), but correcting for this did not account for the difference in diagnostic accuracy. The single variable that accounted for the difference in diagnostic accuracy was examination of the rectum by rigid sigmoidoscopy. CONCLUSION: Rigid sigmoidoscopy significantly improves the diagnostic accuracy of clinical assessment in patients with suspected colorectal cancer. If rigid sigmoidoscopy were omitted in a straight-to-test pathway, some patients would be denied the opportunity for immediate diagnosis.