Non-neurosurgical complications in traumatic neurosurgical ICU patients: A prospective observational study

Introduction: Recognising and treating non-neurological complications occurring in neurotrauma patients during ICU stay is equally challenging. Primary aim: To estimate various non-neurological complications in neurotrauma patients. Secondary aim: To see the effect of these complications on ICU stay, disability and mortality. Methods: Prospective observational study at neurotrauma ICU of level 1 trauma center, AIIMS, New Delhi. 200 neurotrauma patients consisting of Traumatic Brain Injury (TBI) and/or Cervical spine injury (CSI) were enrolled. Period of study: From admission to discharge from ICU or demise. Inclusion criteria: Age >16 years, Severe TBI (GCS≤8), CSI requiring mechanical ventilation. Results: Non–neurological complications were frequent in neurotrauma ICU patients. We observed respiratory complications to be of highest occurence (60.5%). Other complications in decreasing order included dyselectrolytemia (40%), cardiovascular (33.5%), coagulopathy (32%), sepsis (24%), abdominal (16.5%) and AKI (3.5%). Presence of systemic complication except AKI was found to be significantly associated with increased ICU stay. Most of the patients of AKI died early in ICU. Respiratory dysfunction was found to be independently associated with 3.05 times higher risk of worsening clinical condition (disability) (p<0.018). Presence of hypotension during ICU stay (4.2 times, p<0.005), AKI (24.7 times, p<0.02), Coagulopathy (3.13 times, p<0.047) and GCS <6 patients (4.2 times, p<0.006) of TBI were independently associated with significantly increased risk of ICU mortality. Conclusion: Neurotrauma patients tend to have poor outcome due to concomitant non-neurological complications. These have significant bearing on ICU stay, disability and mortality. Early diagnosis and prevention can improve the overall outcome and shorten their ICU stay.