A retrospective cross-sectional analysis of patient characteristics and outcome in the intensive care unit in a tertiary trauma center in the capital city of Nepal
Keywords:
Chronic Obstructive Pulmonary Disease, Intensive Care Units, Traffic Accidents, VentilatorsAbstract
Introduction: The intensive care unit provides intensive care for critically ill or injured patients that is staffed by specially trained medical personnel and has equipment that allows for continuous monitoring and life support. B & B hospital is a tertiary referral center in Nepal with a 13 bedded multispeciality level III unit that predominantly caters to trauma cases. The study aims to identify the cases admitted in the unit, their baseline characteristics and outcomes.
Methods: A descriptive retrospective study of intensive care unit patients of one year was undertaken. Qualitative and quantitative data from all the eligible patients (N=566) admitted from April 14 2019 to April 30, 2020 were included in the study. The prevalence of various diseases including trauma cases and the patient outcomes were analyzed.
Results: A total of 566 patients were admitted among which, 361 (63.78%) were male and 205(36.22%) were females. Among them, 500 (88.33%) were discharged, 40 expired (Mortality Rate=7.06 %) and 26 (4.59%) left against medical advice (LAMA). Most common cause of admission was road traffic accidents accounting for 167 (29.5%) of the total cases followed by fall injury (6.3%) and chronic obstructive lung disease cases (5.9%). Most common causes of infection were urinary tract infection and chest infection accounting for 3.8% The mean duration of stay was 5.89±5.45 days. The mean duration of ventilator use was 4.87±4.069 days.
Conclusions: Traffic accidents are the most common cause of admission. The overall mortality rate is 7.06 % . The major contributor of mortality in trauma cases being severe head injury .
References
Acharya SP. Critical Care Medicine: An emerging super specialty in Nepal. Journal of Society of Anesthesiologists of Nepal [Internet]. Nepal Journals Online (JOL); 2015 Oct 3;1(2):55–8. Available from: http://dx.doi.org/10.3126/jsan.v1i2.13570
Weil MH, Tang W. From Intensive Care to Critical Care Medicine. American Journal of Respiratory and Critical Care Medicine [Internet]. American Thoracic Society; 2011 Jun;183(11):1451–3. Available from: http://dx.doi.org/10.1164/rccm.201008-1341oe
Turner HC, Hao NV, Yacoub S, Hoang VMT, Clifton DA, Thwaites GE, et al. Achieving affordable critical care in low-income and middle-income countries. BMJ Global Health [Internet]. BMJ; 2019 Jun;4(3):e001675. Available from: http://dx.doi.org/10.1136/bmjgh-2019-001675
Pincock S. BjørnAage Ibsen. The Lancet [Internet]. Elsevier BV; 2007 Nov;370(9598):1538. Available from: http://dx.doi.org/10.1016/s0140-6736(07)61650-x
Berthelsen PG, Cronqvist M. The first intensive care unit in the world: Copenhagen 1953. Acta Anaesthesiologica Scandinavica [Internet]. Wiley; 2003 Nov;47(10):1190–5. Available from: http://dx.doi.org/10.1046/j.1399-6576.2003.00256.x
Grenvik A, Pinsky MR. Evolution of the Intensive Care Unit as a Clinical Center and Critical Care Medicine as a Discipline. Critical Care Clinics [Internet]. Elsevier BV; 2009 Jan;25(1):239–50. Available from: http://dx.doi.org/10.1016/j.ccc.2008.11.001
Vincent J-L, Marshall JC, Ñamendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. The Lancet Respiratory Medicine [Internet]. Elsevier BV; 2014 May;2(5):380–6. Available from: http://dx.doi.org/10.1016/s2213-2600(14)70061-x
Marasini BR. HEALTH AND HOSPITAL DEVELOPMENT IN NEPAL: PAST AND PRESENT. Journal of Nepal Medical Association [Internet]. Journal of Nepal Medical Association (JNMA); 2003 Sep 1;42(149):306–11. Available from: http://dx.doi.org/10.31729/jnma.654
Murthy S, Leligdowicz A, Adhikari NKJ. Intensive Care Unit Capacity in Low-Income Countries: A Systematic Review. Azevedo LCP, editor. PLOS ONE [Internet]. Public Library of Science (PLoS); 2015 Jan 24;10(1):e0116949. Available from: http://dx.doi.org/10.1371/journal.pone.0116949
Shrestha RR, Vaidya PR, Bajracharya GR (2011) A survey of adult intensive care units in Kathmandu Valley. Postgrad Med J NAMS 11(2): 1-7.
Dünser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries*. Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2006 Apr;34(4):1234–42. Available from: http://dx.doi.org/10.1097/01.ccm.0000208360.70835.87
Sharma NR. Outcome of intubated post-surgical cases in intensive care unit in Tribhuvan university teaching hospital, Nepal. Journal of Institute of Medicine [Internet]. Nepal Journals Online (JOL); 2007 Jan 5;27(3). Available from: http://dx.doi.org/10.3126/joim.v27i3.413
Koirala S, Ghimire A, Sharma A, Bhattarai B. ICU admission and outcomes in a community-based tertiary care hospital: an audit of one year. Health Renaissance [Internet]. Nepal Journals Online (JOL); 1970 Jan 1;9(2):83–7. Available from: http://dx.doi.org/10.3126/hren.v9i2.4978
Hamal AB. Patients Presenting in Intensive Care Unit of Nepal Police Hospital: An Overview. Journal of Anesthesia and Intensive Care Medicine [Internet]. Juniper Publishers; 2019 Aug 2;9(2). Available from: http://dx.doi.org/10.19080/jaicm.2019.09.555758
Acharya SP, Bhattarai A, Bhattarai B. An Audit of An Intensive Care Unit of A Tertiary Care Hospital. Journal of Nepal Medical Association [Internet]. Journal of Nepal Medical Association (JNMA); 2018 Aug 31;56(212):759–62. Available from: http://dx.doi.org/10.31729/jnma.3703
Murray CJL, Lopez AD. Measuring the Global Burden of Disease. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2013 Aug;369(5):448–57. Available from: http://dx.doi.org/10.1056/nejmra1201534
Neupane HC, Gauli B, Adhikari S, Shrestha N. Contextualizing Critical Care Medicine in the Face of Covid-19 Pandemic. J Nepal Med Assoc [Internet]. 2020Jun.30 ;58(226).
Pant MN, Jha SK, Shrestha S. Cases of Left Against Medical Advice from the Emergency Department of a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study. JNMA J Nepal Med Assoc. 2020 Dec;58(232):992–7. doi: http://dx.doi.org/10.31729/jnma.5411 Epub 2020 Dec 31. PMCID: PMC8028538.
Shrestha T, Pradhananga S, Batajoo KH, Bajracharya M. Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center. JKISTMC 2020;2(2)4: 31- 35.
Ong AW, Omert LA, Vido D, Goodman BM, Protetch J, Rodriguez A, et al. Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study. Crit Care 2009 135 [Internet]. 2009 Sep 24 [cited 2021 Sep 28];13(5):1–9. Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc8054
Kisat MT, Latif A, Zogg CK, Haut ER, Zafar SN, Hashmi ZG, Oyetunji TA, Cornwell III EE, Zafar H, Haider AH. Survival outcomes after prolonged intensive care unit length of stay among trauma patients: The evidence for never giving up. Surgery. 2016 Sep 1;160(3):771-80. https://pubmed.ncbi.nlm.nih.gov/27267552/
Downloads
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
