Demographic Profile and Outcome in Surgically Managed Patients with Chronic Subdural Haematoma: A 9-Year Retrospective Cohort Study.

BACKGROUND: Chronic subdural hematoma (CSDH) is achronic inflammatory and angiogenic condition that is potentially fatal and common among the elderly with a probability of gender, racial and ethnic differences. As our population ages due to increase in our life expectancy, a closer look at this disease in our environment is therefore justified. OBJECTIVES: Our objective is to evaluate the epidemiology, relationship of demography, procedure type and mode of anaesthesia on outcome in the patients. METHODS: Retrospective analyses of patients with CSDHs treated by single burrhole, over a 9-year period was performed. Patients' biodata, type of surgery, mode of anaesthesia and discharge outcome were noted. Data were analysed with chisquare, independent t test and multivariate binary regression. Values of p < 0.05 were considered statistical significance. RESULTS: Two hundred and sixty-four patients were managed during the study period. The male-to-female ratio was 2:1 with mean age of 61.4 years. The peak age range was in the seventh decade. Recurrence and mortality rates were 2.7% and 6.8% respectively. Age was significantly associated with mortality. CONCLUSION: The study showed a male preponderance. Age was significantly associated with mortality. Recurrence of CSDH was not related to patients' age, gender or mode of anaesthesia.

CONTEXTE: L'hématome sous-dural chronique (HSC) est une affection chronique inflammatoire et angiogénique potentiellement mortelle et fréquente chez les personnes âgées avec une probabilité de différences entre les sexes, les races et les ethnies. Comme notre population vieillit en raison de l'augmentation de notre espérance de vie, un examen plus approfondi de cette maladie dans notre environnement est donc justifié. OBJECTIFS: Notre objectif est d'évaluer l'épidémiologie, la relation entre la démographie, le type de procédure et le mode d'anesthésie sur le résultat chez les patients. MÉTHODES: Nous avons effectué une analyse rétrospective des patients atteints de CSDH traités par un seul trou de bavure, sur une période de 9 ans. Les données personnelles des patients, le type de chirurgie, le mode d'anesthésie et le résultat de la sortie ont été notés. Les données ont été analysées à l'aide du test de Chisquare, du test t indépendant et de la régression binaire multivariée. Les valeurs de p < 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: Deux cent soixante-quatre patients ont été pris en charge pendant la période d'étude. Le rapport homme/femme était de 2:1 avec un âge moyen de 61,4 ans. La tranche d'âge maximale se situait dans la septième décennie. Les taux de récidive et de mortalité étaient respectivement de 2,7 % et 6,8 %. L'âge était significativement associé à la mortalité. CONCLUSION: L'étude a montré une prépondérance masculine. L'âge était significativement associé à la mortalité. La récurrence du CSDH n'était pas liée à l'âge, au sexe ou au mode d'anesthésie des patients. Mots-clés: Âge, Hématome sous-dural chronique, Anesthésie locale, Trou de bavure unique.

Neurocritical Care Audit in a Tertiary Institution

Background:The `open' intensive care unit (ICU) predominates in most low and middle economy societies. This is associated with paucity of personnel and cost challenges involved for its maintenance and smooth unning despite the great public demand for this service. Data on neurocritical care in scare in Nigeria and the subregion as a whole. Our objective is to audit our neurocritical care facility; human resources; patient admission and outcome. Patients and Method: We conducted a retrospective audit of all patients admitted to our `open' ICU following a neurological indication. This study was carried out over a one year period (January 2008-December 2008). In addition to patients' boidata; we recorded date of admission; indication for admission; treatment (operative/non-operative); ventilatory support if any; and outcome (Alive or dead). Results: One hundred and twenty-nine patients were admitted during the study period; 85 (65.9) of which was due primarily to a Neurosurgical indication. The overall mortality was 25.9while mortality of ventilated patients was 64.5Mortality rate was significantly by ventilation.Conclusion: Neurological patients account for most of our ICU admission. Hospitals with ICUs should ensure that they have a proper high dependency unit. We also ecommend that appropriate equipments and staff training in the area of neurocritical care be incorporated into existing `open' ICUs in our environment. The use of protocol for ventilated patients and managing common ICU cases and common procedures should enhance treatment outcomes