Evaluating complications in a South African neurocritical care unit: A 1-year retrospective audit.

Background: The benefits of setting up a dedicated neurocritical care unit (NCCU) for critically ill neurological patients are well documented. These units are specifically designed to care for individuals with conditions affecting the brain and spine. However, complications particular to these units in low- and middle-income countries are not widely reported. Objectives: To describe the complications observed in an NCCU at a tertiary-level academic hospital over the course of 1 year and examine their link with intensive care unit (ICU) length of stay (LOS) and mortality rates. Methods: The study involved retrospective analysis of complications experienced by critically ill neurological patients admitted to the NCCU between 1 January and 31 December 2020, according to the NCCU patient data registry. Results: A total of 850 patients, most of whom were male (61.2% in the high-care unit (HCU) and 68.1% in the ICU), were admitted to the NCCU, with a median age of 43 years and 41 years in the HCU and the ICU, respectively. The overall rate of complications was 38.2% (n=325/850 patients). Statistically significant complications (p<0.05) included metabolic and electrolyte imbalances, infections (including ventilator-associated pneumonia, surgical site infections and central line-associated bloodstream infections), and deep-vein thrombosis. The most common complication was metabolic disturbances (28.2%), particularly sodium homoeostasis abnormalities. The number of complications significantly affected NCCU LOS (p<0.001), but did not have a statistically significant impact on mortality (p=0.067). Conclusion: Complications occurred in 38.2% of critically ill neurological patients in a specialised NCCU in a tertiary-level academic hospital in South Africa, primarily involving electrolyte disturbances and infections. These complications were linked to longer LOS in the ICU, but did not significantly increase the risk of mortality. Contribution of the study: This study provides valuable insight into the burden and nature of complications encountered in a resource-constrained neurocritical care setting. By systematically identifying and quantifying clinical complications over a defined period, the article highlights critical areas for intervention and quality improvement. It contributes to the global body of neurocritical care literature by offering context-specific data from a low- to middle-income country, thereby addressing a significant gap in regional and global neurocritical care outcomes research. The findings support the development of targeted strategies to enhance patient safety, optimise resource use, and improve clinical outcomes in similar healthcare environments.