The Pattern of Medical Admissions at the Intensive Care Unit of the University of Port Harcourt Teaching Hospital, Nigeria

Main Article Content

Otokwala Job Gogo
Akpa Maclean Romokere
Stanley Rosemary Oluchi

Keywords

Pattern, Medical Admissions, Intensive Care Unit , Port Harcourt

Abstract

Background: Intensive care units offer specialized care to critically ill patients and are an integral part of modern health care. In low-income countries, with limited resources, the demand to optimize patient care and improve outcomes depends on a better understanding of the pattern of medical referrals to the ICU for varying reasons of resource allocation, staffing, and quality improvement initiatives. This study aims to describe and provide valuable insights into the patterns of medical admissions to the intensive care unit (ICU), including case mixes, intensive care interventions, duration of stay, and outcomes to highlight the need for proper resource allocation


 


Methodology: A retrospective descriptive study was conducted at the University of Port Harcourt Teaching Hospital ICU between January 2022 and December 2024. We reviewed all patients from the Department of Internal Medicine referred to the ICU with a purely medical diagnosis. Data were retrieved from the ICU admissions register and patients' medical records following ethical exemption approval.


 


Results: A total of 377 patients with medical referrals were reviewed, accounting for approximately 56.9% of all ICU admissions. More males were admitted, and the mean age of patients was 48.6 ± 15.3 years. The emergency unit was the commonest source of referral and offered a significant source of in hospital delays prior to transfer to the ICU. The most common indication for ICU admission was stroke, with hemorrhagic stroke, sepsis, and cardiogenic shock associated with the worst outcomes.


 


Conclusion: Stroke predominated medical referrals and provided the worst outcome. The in-hospital delays at the emergency unit which became the largest source of referral contributed to the high mortality. This study highlights the need to strengthen stroke care at the tertiary level of care as well as other medical referrals to improve care.

Abstract 89 | PDF Downloads 68 EPUB Downloads 3

References

1. Miranda JJ, Kinra S, Casas JP, Davey GS, Ebrahim S. Non-communicable diseases in Low and Middle-income countries: Context, determinants and health policy. Tropical Medicine &International health 2008;13(10): 1225-1234.

2. Odunyemi A, Rahman T, Alam K. Economic burden of non-communicable diseases on households in Nigeria: Evidence from the Nigeria living standard survey. BMC public health 2018; 23: 1563( 2023).

3. Crawford AM, Shiferaw AA, Ntambwe P et al. Global critical care:a call to action. Crit Care 2023;27:28 https://doi.org/10.1186/s13054-022-04296-3

4. Oyadiran OT, Agaga LA, Adebayo AY, Lucero-Prisno DE. Nigeria, COVID 19 and the dearth of health workers. J. Glob Health 2020; Dec: 10(2):0203379. Doi:10.7189/jogh.10.020379.

5. Ogunbiyi O, Sanusi A, Osinaike B, Yakubu S, Rotimi M, Fatungase O. An overview of intensive care unit services in Nigeria. J Crit Care 2021;66:160-165. https://doi.org/10.1016/j.jcrc.2021.07.007.

6. Akinjola OE, Olateju SO, Idowu AO, Adetoye AO, Ogunmodede AF, Andero V, Komolafe MA. Indications and outcomes of medical intensive care admissions in a Nigerian tertiary hospital. Annals of Health Research 2023; 313-321

7. Oke DA. Medical admission into the intensive care unit (ICU) of the Lagos University teaching hospital. Niger Postgrad Med J 2001; 8:179-189

8. Ilori IU, Kalu QN. Intensive Care admissions and outcome at the University of Calabar teaching hospital. Niger J Crit Care 2012; 27: 105: e1-4

9. NIH Consensus Statement. Crit Care Med 1983 Mar 7-9; 46:1-26

10. Akinjola OE 1, Olateju SO, Idowu AO, Aaron OI, Adetoye AO, Ogunmodede AF, Andero V, Komolafe M. Annals of Health Research (The Journal of the Medical and Dental Consultants’ Association of Nigeria, OOUTH, Sagamu, Nigeria) CC BY-NC Volume 9, Issue 3: 313-321 December 2023 doi:10.30442/ahr.0904-04-216A4.

11. Mato CN, Onwuchekwa AC, Aggo AT. The pattern of admission to the University of Port Harcourt Teaching Hospital ( UPTH) intensive care Unit-A ten 10-year analysis. South AM J Crit Care 2009;25:10

12. Ebirim L, Ojum S. Outcome of trauma admissions in an intensive care unit in the Niger Delta region of Nigeria. The Internet Journal of critical care and emergency medicine 2012; 12:1

13. Poluyi EO, Fadiran OO, Poluyi CO, et al. Profile of intensive care unit admissions and outcomes in a tertiary care centre of a developing country in West Africa: A 5year analysis. J Intensive &Crit Care 2016,2:3

14. Eze CO, Okoro FC, Nnaji T, Nwobodo M, Kalu U, Ewah R. Mortality pattern in intensive care unit: Experience at Abakaliki Southeastern Nigeria. World J Cardiovascular Dis 2020; 10:473-482.

15. Iyoha EI, Okwilagwe H, Okonmah KU, Irabor J, Olowo-Samuel O, Aiyenuberun SV. Admission Patterns and Patient Outcomes in Intensive Care Delivery at a Rural Tertiary Hospital in Southern Nigeria: A Five-Year Retrospective Review. Cureus. 2024 Nov 7;16(11): e73251.

16. Mathews KS, Durst MS, Vargas-Torres C, Olson AD, Mazumdar M, Richardson LD. Effect of Emergency Department and ICU occupancy on admission Decisions and outcomes for critically ill patients. Crit Care Med 2018 May; 46(5):720-727.

17. Kannan S, Giuriato M, Song Z. Utilization and Outcomes in U.S. ICU Hospitalizations. Crit Care Med. 2024 Sep 1;52(9):1333-1343.

18. Tsai IT, Sun CK, Chang CS, Lee KH, Liang CY, Hsu CW. Characteristics and outcomes of patients with emergency department revisit within 72 hours and subsequent admission to the intensive care unit. Tzu Chi Med J. 2016 Oct-Dec;28(4):151-156.

19. Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, Bonametti AM. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011;15(1): R28.

20. Sridharan G, Fleury Y, Hergafi L, Doll S. Triage of critically ill patients: Characteristics and outcomes of patients refused as well for intensive care J. Clin.Med.2023;12(17): 5513.

21. Backhaus R, Aigner F, Schlachetzki F, Steffling D, Jacob W et al. Inventory of neurological intensive care unit: who is treated and how long? Neurol Res Int 2015; 2015-696038

22. Tesema HG, Lema GF, Mesfin N et al. Patterns of admission and clinical outcomes among patients admitted to the medical intensive care unit of a teaching and referral hospital in Northwest Ethiopia. Globe Adv Health Med 2021; 10:216495612198258