Assessment of disease pattern and drug utilization among neurology intensive care unit patients in a developing country: an observational analysis

ABSTRACT

Objective

This study aimed to assess the disease pattern and drug utilization among admitted patients in a tertiary-care hospital’s neurology intensive care unit (neuro ICU).

Methods

A prospective observational cohort study was conducted between August 2022 and January 2023. Patients of any age and gender admitted to the neuro ICU were included, but those who declined to participate were excluded. Demographics, clinical, and medication details were consistently gathered and maintained until discharge. The World Health Organization (WHO)/International Network of Rational Use of Drugs (INRUD) prescribing indicators and the Anatomical Therapeutic Chemical (ATC) classification/Defined Daily Dose (DDD) system were used to evaluate drug use.

Results

A total of 516 patients were included, predominantly male (65.1%), with an average age of 54.62 ± 15.02 years. The most common diagnosis was stroke [72.3%, comprised of hemorrhagic (46.7%) and ischemic (25.6%)], followed by seizure disorders (6.6%), and central nervous system infections (5.4%). Patients received an average of 7.8 medications, 32.3% prescribed by generic name, 16.0% antibiotics, 74.1% injections, and 100% essential drugs. A (28.5%), C (19.2%), N (17.3%), J (19.2%), B (13.5%), and R (2.3%) were commonly prescribed ATC classes of medications. Number of DDDs was maximum for pantoprazole and furosemide. Based on discharged status, 41.0% were discharged on request, 24.8% against medical advice, 23.8% routine, and 10.2% mortality during hospitalization.

Conclusion

Our study reveals a high prevalence of hemorrhagic stroke, especially among men, diverging from global ischemic stroke trends. Irregular hypertension treatment is the primary cause, exacerbated by low healthcare knowledge in rural areas, where patients often discharge on request, probably due to poor socio-economic conditions. Urgent public awareness campaigns and further research are needed to address this elevated hemorrhagic stroke incidence.

KEYWORDS:

• Drug utilization evaluation
• emergency care
• neurological disorders
• neurology intensive care unit
• stroke

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Study concept and design: Krishna Undela, Amit Ranjan Barua, and Mausumi Barthakur. Literature review: Mamidi Niveditha and Ruby Kasana. Acquisition, collection, analysis, or interpretation of data: Mamidi Niveditha and Ruby Kasana. Drafting of the manuscript: Mamidi Niveditha and Ruby Kasana. Critical revision of the manuscript: Krishna Undela, Amit Ranjan Barua, and Mausumi Barthakur. All authors gave final approval and agreed to be accountable for all aspects of the work, ensuring integrity and accuracy.

Acknowledgments

The authors sincerely acknowledge the Department of Pharmaceuticals under the Ministry of Chemicals and Fertilizers, Government of India, and NIPER Guwahati for their extensive support. A special thanks to the doctors and staff of the neuro ICU and the entire team of the GNRC Institute of Medical Science, North Guwahati, Assam, for their constant support for data collection. We would also like to thank all the patients who participated in this study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21548331.2024.2358747

Additional information

Funding

This paper was not funded.