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A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with stroke: A developing state scenario

Khan, Mudassir Azeez and Sankapithilu, Ganraj Bhat and Nagaraja, Vinayak and Chandra, Subhash (2010) A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with stroke: A developing state scenario. [Journal (On-line/Unpaginated)]

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Abstract

Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females) of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics) with mean (SD) age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002)], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516), sex (p=0.460), number of episodes (0.795), underlying hypertension (p=0.905). Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004), in patients with right-sided compared with left-sided hemiplegic (p=0.029) and who couldn’t afford computed tomography (CT) scan (p=0.007). Kaplan Meier curve in Image-1 shows the survival following admission to emergency ward. Conclusion: Adequate measures need to be taken to improve the public awareness of stroke and the role of local doctors. Our study has shown that active smokers, involvement of the right side and non performance of CT were independent predictors of mortality which have not been shown earlier. Also, we found that diabetes mellitus is independent predictor of mortality in stroke, which has been seen in earlier studies too.

Item Type:Journal (On-line/Unpaginated)
Keywords:Epidemiology; Stroke; Thrombolytic therapy
Subjects:JOURNALS > Online Journal of Health and Allied Sciences
ID Code:7184
Deposited By: Kakkilaya Bevinje, Dr. Srinivas
Deposited On:16 Feb 2011 19:47
Last Modified:11 Mar 2011 08:57

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1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997;349(9064):1498-1504.

2. Das SK, Banerjee TK et al. A prospective community-based study of stroke in Kolkata, India. Stroke. Epub 2007 Feb 1;38(3):906-910.

3. Brown RD, Whisnant JP et al. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke. 1996;27(3):373-380.

4. Kolominsky R, Sarti C et al. A prospective community-based study of stroke in Germany--the Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 1998;29(12):2501-2506.

5. Rothwell PM, Coull AJ et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxford shire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;63(9425):1925-1933.

6. Syme PD, Byrne AW et al. Community-based stroke incidence in a Scottish population: the Scottish Borders Stroke Study. Stroke. Epub 2005 Aug 4;36(9):1837-1843.

7. Stroke epidemiological data of nine Asian countries. Asian Acute Stroke Advisory Panel (AASAP). J Med Assoc Thai. 2000;83(1):1-7.

8. Pandian JD, Srikanth V et al. Poverty and stroke in India: a time to act. Stroke. Epub 2007 Oct 22;38(11):3063-3069.

9. Durai PJ, Padma V et al. Stroke and thrombolysis in developing countries. Int J Stroke 2007;2(1):17-26.

10. Practice advisory: thrombolytic therapy for acute ischemic stroke--summary statement. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1996;47(3):835-839.

11. Hacke W, Donnan G et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS r-tPA stroke trials. Lancet. 2004;363(9411):768-774.

12. Hacke W, Kaste M et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359(13):1317-1329.

13. Wardlaw JM, Murray V et al. Thrombolysis for acute ischemic stroke. Cochrane Database Syst Rev 2009(4):CD000213.

14. Derex L, Adeleine P et al. Factors influencing early admission in a French stroke unit. Stroke 2002;33(1):153-159.

15. Chang KC, Tseng MC et al. Pre hospital delay after acute stroke in Kaohsiung, Taiwan. Stroke. Epub 2004 Feb 12;35(3):700-704.

16. Maze LM, Bakas T. Factors associated with hospital arrival time for stroke patients. J Neurosci Nurs 2004;36(3):136-141, 155.

17. Maestroni A, Mandelli C et al. Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy. Emerg Med J. 2008;25(6):340-345.

18. Turin TC, Kita Y et al. The time interval window between stroke onset and hospitalization and its related factors. Neuroepidemiology Epub 2009 Jul 27;33(3):240-246.

19. Key P. Women, health and development, with special reference to Indian women. Health Policy and Planning. 1987;2(1):58-69.

20. Sweileh WM, Sawalha AF et al. Predictors of in-Hospital Mortality after Acute Stroke: Impact of Gender. Int J Clin Exp Med. Epub 2009 Jan 30;2(1):41-47.

21. Heuschmann PU, Kolominsky PL et al. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group. Arch Intern Med. 2004;164(16):1761-1768.

22. Carter AM, Catto AJ et al. Predictive variables for mortality after acute ischemic stroke. Stroke. Epub 2007 Apr 19;38(6):1873-1880

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