Clinical profile and in-hospital outcomes of neurological emergencies at a tertiary referral hospital in Somalia: a prospective cohort study

Evidence describing neurological emergencies and their hospital outcomes in Somalia remains limited. We aimed to characterise the demographic and clinical profile, diagnostic spectrum, presentation timing, disposition and in-hospital outcomes of patients presenting with neurological emergencies to a tertiary referral hospital in Mogadishu. This prospective hospital-based cohort study enrolled patients aged ≥17 years presenting with neurological emergencies to the emergency department from 10 July 2025 to 11 July 2026. Of 482 potentially eligible neurological presentations screened, 321 unique patients were enrolled after 161 pre-enrolment exclusions. Verbal informed consent was obtained from the patient or, when appropriate, a parent/guardian or legally acceptable representative. Baseline characteristics were described for all 321 participants. In-hospital mortality was calculated among 294 admitted patients with a definitive discharge-alive or death outcome using an exact binomial 95% confidence interval (CI). Among 321 enrolled patients, 181 (56.4%) were male and 166 (51.7%) were aged >50 years. Ischaemic stroke (123; 38.3%), epilepsy (62; 19.3%), haemorrhagic stroke (49; 15.3%) and status epilepticus (33; 10.3%) were the leading diagnoses. Presentation occurred more than six hours after symptom onset in 229 patients (71.3%). Overall, 295 patients were admitted and 26 self-discharged from the emergency department; one admitted patient had no definitive final outcome. Among 294 patients with definitive inpatient outcomes, 263 were discharged alive and 31 died (10.5%; exact 95% CI 7.3–14.6%). Stroke and seizure-related disorders accounted for most neurological emergencies in this prospective cohort, delayed presentation was common and approximately one in ten admitted patients with a definitive outcome died during hospitalisation. The findings support prospective neurological-emergency surveillance, improved time-to-care measurement and more complete severity, treatment and follow-up data in Somalia.