(183) Assessment of the Disease Pattern and Drug Utilization among the Neuro ICU Patients

Publication Number: 518

Background: The burden of neurocritical disease is disproportionately high in developing nations, whose healthcare systems struggle to properly care for patients in the neuro ICU with complicated and life-threatening neurologic injuries.

Objectives: To assess the disease pattern and drug utilization among neuro ICU patients using WHO core drug prescribing indicators and WHO ATC classification at a tertiary care neurology specialty hospital.

Methods: A prospective observational cohort study was conducted between August and December 2022. Patients admitted to the neuro ICU of any age or gender were included, and those wish not to participate were excluded. Patient demographic data, prior medical history, clinical diagnosis, and medication details were collected in a structured data collection form. Patients were followed till discharge to update the data and collect the discharge summary. SPSS (IBM, ver. 29.0.) was used for data analysis.

Results: There were 412 patients admitted; 65% (Male) and an average age of 54.57±14.8 years. The most often diagnosed condition was a stroke comprised of 105 (36.1%) ischemic strokes and 172 (63.9%) hemorrhagic strokes. Afterward, various neurological conditions (19%), seizure disorders (8%), and CNS infections (6%) came in sequence. The average number of medications per counter was 1.23, with 35% of those being prescribed by their generic names, 17% including antibiotics, 71% involving injections, and 100% coming from the list of essential medications. Commonly prescribed classes of drugs were ATC class A: 29% (Pantoprazole, Ondansetron), C: 19% (Atorvastatin, Furosemide, Amlodipine, Labetalol), N: 18% (Sodium valproate, Levetiracetam, Paracetamol, Prochlorperazine), J: 17% (Ceftriaxone, Piperacillin + Tazobactam, Meropenem, Cefuroxime), B: 14% (Mannitol, Aspirin), and R: 3% (Dexamethasone). A total of 107 patients (26%) were routinely discharged from the hospital, 101 (24%) were discharged against medical advice, and 168 (41%) were discharged at the patient's request. The mortality rate was found to be 8.7% (36 patients), with 21 (58%) dying as a result of increasing intracranial pressure with a midline shift in the CT scans, eight (22%) from sepsis, and seven (20%) from various other illnesses.

Conclusions: From this continuously monitored study in the neuro ICU we observed that the most diagnosed condition was a hemorrhagic stroke. Mannitol was the commonly prescribed drug for hemorrhagic stroke and occasionally for ischemic stroke. Ceftriaxone was the antibiotic that was most frequently proposed for the prophylaxis of secondary infection among patients in neuro ICU. In neuro ICU, mortality was mainly observed among the patients with midline shift hemorrhage.