Nihilism in Emergency Neurosurgical Patients in a Rural Setup: Our Experience

Aim: To evaluate the aspect of Clinical Nihilism and Self fullled prophecy (SFP) in emergency neurosurgical patients in our Centre, Jorhat Medical College Hospital. Method and materials: A retrospective analysis was done in Jorhat medical college from November 2016 to October 2018 in which 483 patients critically ill patient evaluated with predicted poor outcome or death by neurosurgery department were included in the study. Data was collected using patients' data sheets and presented in tables and graphs. Simple descriptive data analysis was done with MS Excel. Results and observation: 483 patients who were predicted with poor outcome or death were included in our study. Among these 49 patients underwent operative management (14%) and 304 patients were treated medically (86%). The mortality in post operative group was 3 (6%) and in that of medical group were 42 (14%). 130 patients refused aggressive management (27%) and left against medical advice of which 113 (87%) died during transportation. 4 patients (3%) came back for follow up after 1 month with neurological improvement and rest 13 patients lost to follow up.64.5 % patients survived who were critically ill and was expected to have a poor outcome. Conclusion: There is no universally accepted accurate prediction model. Decisions to limit treatment should be balanced with avoidance of self-fullling prophecies of poor outcome due to clinical nihilism.