scholarly journals Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

2019 ◽  
Author(s):  
Seid Getahun Abdella ◽  
Nebiyu Bekele Gebi ◽  
Ermias Shenkutie Gerffie ◽  
Koku Sisay Tamirat
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Regression Model ◽  
Hospital Stay ◽  
Functional Impairment ◽  
Associated Factors ◽  
Stroke Care ◽  
Post Stroke ◽  
Stroke Disability

Abstract Background: Epidemiological transitions and widespread risk factors made stroke common health problem in sub-Saharan countries in the early age. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals which increased patient survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: An institution based cross-sectional study was employed from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data were collected using structured questionnaire from secondary sources of patient medical records. In-hospital mortality and poor post-stroke disability (greater functional impairment, when Modified Rankin Scale score (mRS) ≥3) were outcome variables. Binary logistic regression model was fitted to identify predictor variables. Adjusted Odds Ratio (OR) with a 95% confidence interval (CI) used to assess the strength of association. Variables with p-value less than 0.05 in the multi-variable regression model was considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall in-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor post-stroke disability was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor post-stroke disability at discharge. Conclusion: Ischemic stroke was the most common stroke subtype. In-hospital mortality was relatively lower. However, greater functional impairment was high at discharge. Stroke morality was observed lower among male and longer in-hospital stay patients, while evidence of increased intracranial pressure was associated with poor post-stroke disability at discharge.

scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

scholarly journals Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

2019 ◽  
Author(s):  
Seid Getahun Abdella ◽  
Nebiyu Bekele Gebi ◽  
Ermias Shenkutie Gerffie ◽  
Koku Sisay Tamirat
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Associated Factors ◽  
Public Health Problem ◽  
Stroke Care ◽  
Clinical Profile ◽  
P Value ◽  
Post Discharge ◽  
Hospital Outcome ◽  
Disability Outcome

Abstract Background: Stroke is the leading public health problem globally. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals that showed patients increased survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: Hospital based cross sectional study was conducted from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data was collected using standardized questionnaire from secondary sources like patients medical records. Binary logistic regression were fitted to identify predictor variables. Adjusted Odds ratio(OR) with 95% confidence interval was computed and variables with p-value less than 0.05 in the multi-variable regression model considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall In-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor disability outcome at discharge was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor disability outcome at discharge. Conclusion: In-hospital mortality was lower than previous studies. However post-discharge disability is higher. Male sex, length of in-hospital stay, was significant predictors of in-hospital mortality. Increased intracranial pressure was also significant predictor of poor disability outcome at discharge. Key words: In hospital outcome, Mortality, poor outcome, stroke care unit, Gondar

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

scholarly journals Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

2021 ◽  
Vol 65 (5) ◽  
pp. 322-330
Author(s):  
J. Salvador Marín ◽  
F.J. Ferrández Martínez ◽  
C. Fuster Such ◽  
J.M. Seguí Ripoll ◽  
D. Orozco Beltrán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
High Length

Admission Hemoglobin Is Prognostic for In-Hospital Mortality in Oldest-Old Patients with Acute Ischemic Stroke

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mingquan Li ◽  
Xiaoyun Liu ◽  
Liumin Wang ◽  
Lei Shu ◽  
Liqin Luan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Oldest Old ◽  
Final Analysis ◽  
Short Term ◽  
Old Patients ◽  
Short Term Mortality ◽  
Tertiary Hospitals

<b><i>Introduction:</i></b> Anemia is a common condition encountered in acute ischemic stroke, and only a few pieces of evidence has been produced suggesting its possible association with short-term mortality have been produced. The study sought to assess whether admission anemia status had any impact on short-term clinical outcome among oldest-old patients with acute ischemic stroke. <b><i>Materials and Methods:</i></b> A retrospective review of Electronic Medical Recording System was performed in 2 tertiary hospitals. Data, from the oldest-old patients aged &#x3e; = 80 years consecutively admitted with a diagnosis of acute ischemic stroke between January 1, 2015, and December 31, 2019, were analyzed. Admission hemoglobin was used as indicator for anemia and severity. Univariate and multivariate regression analyses were used to compare in-hospital mortality and length of in-hospital stay in different anemia statuses and normal hemoglobin patients. <b><i>Results:</i></b> A total of 705 acute ischemic stroke patients were admitted, and 572 were included in the final analysis. Of included patients, 240 of them were anemic and 332 nonanemic patients. A statistical difference between the 2 groups was found in in-hospital mortality (<i>p</i> &#x3c; 0.001). After adjustment for baseline characteristics, the odds ratio value of anemia for mortality were 3.91 (95% confidence intervals (CI) 1.60–9.61, <i>p</i> = 0.003) and 7.15 (95% CI: 1.46–34.90, <i>p</i> = 0.015) in moderate and severely anemic patients, respectively. Similarly, length of in-hospital stay was longer in anemic patients (21.64 ± 6.17 days) than in nonanemic patients (19.08 ± 5.48 days, <i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Increased severity of anemia may be an independent risk factor for increased in-hospital mortality and longer length of stay in oldest-old patients with acute ischemic stroke.

scholarly journals Risk Factors for In-Hospital Mortality among Ischemic Stroke Patients in Southern Taiwan

2016 ◽  
Vol 10 (2) ◽  
pp. 86-90 ◽  
Author(s):  
Cheung-Ter Ong ◽  
Sheng-Feng Sung ◽  
Yi-Sin Wong ◽  
Chi-Shun Wu ◽  
Yung-Chu Hsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Stroke Patients ◽  
Southern Taiwan

Abstract 5: Do Stroke Centers Reduce Mortality for Patients with Acute Ischemic Stroke? An Instrumental Variable Analysis

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Robert G Holloway ◽  
Katia Noyes ◽  
Manish N Shah ◽  
Bruce Friedman
Keyword(s):  
New York ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
New York State ◽  
Selection Effect ◽  
Stroke Care ◽  
Instrumental Variable Analysis ◽  
All Cause Mortality ◽  
Stroke Center

Background: Although the establishment of stroke centers based on the Brain Attack Coalition recommendations has great potential to improve quality of stroke care, little is known about whether stroke centers improve health outcomes such as mortality. Methods: Using 2005-2006 New York State Statewide Planning and Research Cooperative System data, we identified 32,783 hospitalized patients age 18+ with a principal diagnosis of acute ischemic stroke (ICD-9 433.x1, 434.x1 and 436). We compared in-hospital mortality and up to one year all-cause mortality between New York State Designated Stroke Centers and non-stroke center hospitals. Because patients were not randomly assigned to hospitals, stroke centers might treat different types of patients than other hospitals (a selection effect). We used a “natural randomization” approach, instrumental variable analysis (differential distance was the instrument), to control for this selection effect. To determine whether the mortality difference was specific to stroke care, we repeated the analysis using a different group of patients with gastrointestinal (GI) hemorrhage (N=53,077). Results: Of the 32,783 stroke patients, nearly 50% (16,258) were admitted to stroke centers. Stroke centers had lower unadjusted in-hospital mortality and 30-, 90-, 180-, and 365-day all-cause mortality than non-stroke centers (7.0% vs. 7.8%, 10.0% vs. 12.6%, 14.6% vs. 17.5%, 18.0% vs. 21.0%, 22.4% vs. 26.2%, respectively). After adjusting for patient and hospital characteristics, comorbidities, and the patient selection effect, stroke centers were associated with significantly lower all-cause mortality. The adjusted differences were -2.6%, -2.7%, -1.8%, and -2.3% for 30-, 90-, 180- and 365-day mortality (all p<0.05). The adjusted difference in in-hospital mortality was -0.8% but was not statistically significant. In a specificity analysis of patients with GI hemorrhage, stroke centers had slightly higher mortality. Conclusions: Hospitals that are Designated Stroke Centers had lower mortality for acute ischemic stroke than non-stroke center hospitals. The mortality benefit was specific to stroke and was not observed for GI hemorrhage. Providing stroke centers nationwide has the potential to reduce mortality.

Abstract TP319: Risk Factors of Post-stroke Epilepsy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tatyana Danilova ◽  
Dina Khasanova
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Functional Neuroimaging ◽  
Cerebral Arteries ◽  
Transcranial Doppler Sonography ◽  
Epileptic Seizures ◽  
Brain Lesions ◽  
Control Group ◽  
Ischemic Brain ◽  
Post Stroke

Purpose: The aim of the study was to identify the risk factors for seizures in patients with ischemic stroke using clinical, functional, neuroimaging research methods. Materials and methods: The results of the complex survey of 468 patients suffering from ischemic stroke (256 patients experienced epileptic seizures and 203 experienced no epileptic seizures) are presented. The diagnostic procedures included clinical evaluation, magnetic resonance imaging, electroencephalography, extracranial and transcranial Doppler sonography. In addition the assessment of the rate of sodium lithium countertransport (the marker of genetically determined on transport mechanisms of cell membranes) in patients with c ischemic stroke with the development of epileptic seizures and no seizures was carried out. Results: The focal seizures are the most common (92,5%). Cortical ischemic brain lesions prevailed in patients with seizures (81,1%), whereas in the control group cortex was affected in 38,9% patients (χ2=89.2, <0,001). Stenosis of cerebral arteries was more common in patients with epilepsy (82.3%) compared to patients without seizures (74.4%, <0.05). Reduced cerebrovascular reactivity (CVR) in vertebro-basilar basin was more frequently detected in patients with seizures (85.9%, p<0.001) compared to controls (71.6%). CVR < 10% was registered in 33.8% patients with seizures versus 13.4% controls (p<0.001). Patients with epileptic seizures showed cerebral perfusion reduction mostly in vertebro-basilar basin (85.9%) rather than in carotid basin (61.2%, p<0.001). Patients experienced epileptic seizures had high rates of sodium-lithium antitransport (> 346 μmol/liter cells x hour) more often than patients without epileptic seizures (52,6% and 35,5%, respectively, <0,05). Patients experienced epileptic seizures with high rates of sodium-lithium antitransport had a higher seizure frequency than patients with low rates of sodium-lithium antitransport. Conclusion: Thus, cortical ischemic brain lesions, significant stenosis of cerebral arteries, predominant perfusion reserve reduction in the posterior cerebral circulation, as well as a high rate of sodium lithium countertransport may be considered as risk factors for post-stroke epilepsy.

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