Neurosurgical Emergencies in a University Hospital in a Sub-Saharan African Country

Background: In sub-Saharan Africa, neurosurgical emergencies are a major public health concern due to their frequency, severity, and the lack of specialized resources. Traumatic causes represent up to 90% of cases, largely driven by road traffic accidents linked to motorcycle use and insufficient protective measures. Management guidelines mainly originate from high-income countries and are difficult to apply in low- and middle-income contexts. This study aimed to describe the epidemiological, clinical, and therapeutic profile of neurosurgical emergencies and to identify mortality-associated factors at the Emergency Department of Gabriel Touré University Hospital in Bamako, Mali. Methods: A prospective observational study was conducted from January 1 to December 31, 2021, at the Emergency Department of Gabriel Touré University Hospital, Mali’s main tertiary referral center. All patients with CT-confirmed traumatic or non-traumatic neurosurgical lesions were included. Data were collected using a standardized form and analyzed with SPSS^？ 26. Associations were evaluated using Pearson’s chi-square test with significance set at p < 0.05. Results: Among 19,215 admissions, 894 patients (4.6%) presented with neurosurgical emergencies. The mean age was 20 years, with a male-to-female ratio of 5.3. Traumatic etiologies accounted for 90.8% of cases, mainly road traffic accidents (64.4%), followed by falls (13.8%) and assaults (10.4%). Non-traumatic lesions, mostly vascular, represented 12%. The mean admission delay was 4 hours, with nearly half of patients transported by non-medical means. A GCS ≤ 8 was recorded in 13% of patients, 28.6% of whom presented with respiratory distress. CT most commonly showed subarachnoid hemorrhage (28%), cerebral contusion (27.7%), and acute subdural hematoma (16%). Emergency neurosurgical intervention was required in 121 patients (13.5%), with 54.5% operated within 24 hours, though the average waiting time remained 12 hours. Overall mortality reached 21%. Mortality was significantly associated with vascular etiology (p = 0.001), initial loss of consciousness (p < 0.0001), neurological deficit (p < 0.0001), endotracheal intubation (p < 0.0001), and GCS ≤ 8 (p < 0.0001). Conclusion: Neurosurgical emergencies in Mali are largely due to traumatic brain injuries from road traffic accidents, predominantly affecting young men. Mortality remains high because of the lack of prehospital care, delayed admissions, and prolonged