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Poll M, Martins RT, Anschau F, Jotz GP. Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil. Healthcare (Basel) 2024; 12:836. [PMID: 38667598 PMCID: PMC11050536 DOI: 10.3390/healthcare12080836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Stroke constitutes a significant global cause of mortality and disability. The implementation of stroke units influences hospital quality indicators, guiding care management. We aimed to compare hospital length of stay (LOS), in-hospital mortality, and post-discharge mortality between stroke patients admitted in the pre- and post-implementation periods of a stroke unit in a public hospital in southern Brazil. This retrospective cohort study used real-world data from one reference hospital, focusing on the intervention (stroke unit) and comparing it to the general ward (control). We analyzed the electronic medical records of 674 patients admitted from 2009 to 2012 in the general ward and 766 patients from 2013 to 2018 in the stroke unit. Admission to the stroke unit was associated with a 43% reduction in the likelihood of prolonged hospitalization. However, there was no significant difference in the risk of in-hospital mortality between the groups (Hazard ratio = 0.90; Interquartile range = 0.58 to 1.39). The incidence of death at three, six and twelve months post-discharge did not differ between the groups. Our study results indicate significant improvements in care processes for SU patients, including shorter LOS and better adherence to treatment protocols. However, our observations revealed no significant difference in mortality rates, either during hospitalization or after discharge, between the SU and GW groups. While SU implementation enhances efficiency in stroke care, further research is needed to explore long-term outcomes and optimize management strategies.
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Affiliation(s)
- Marcia Poll
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Rodrigo Targa Martins
- Stroke Unit Coordination, Conceição Hospital Group, Porto Alegre 91350-200, RS, Brazil
| | - Fernando Anschau
- Conceição Hospital Group, Department of Education and Research Coordination, Porto Alegre 91350-200, RS, Brazil
| | - Geraldo Pereira Jotz
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
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Shankaranarayana AM, Jagadish A, Nimmy J, Natarajan M, Janssen H, Solomon JM. Non-therapeutic strategies to promote physical activity of stroke survivors in hospital settings: A systematic review. J Bodyw Mov Ther 2023; 36:192-202. [PMID: 37949559 DOI: 10.1016/j.jbmt.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/11/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To systematically summarize the evidence of strategies other than therapy to promote physical activity in hospital settings. METHODS Studies testing the various strategies to promote the physical activity of stroke survivors in different hospital settings, including stroke units, hospitals and rehabilitation centres were included. Two independent reviewers screened, extracted data, and assessed the study quality. Quality assessments were performed using standardized checklists. Data synthesis was done from the selected articles and results were reported. RESULTS Of the 3396 records retrieved from database searches, 12 studies (n = 529 participants) were included. All the studies were of moderate to good quality. The strategies were grouped into five categories: i) physical environment, ii) device-based feedback, iii) self-management approaches, iv) family presence, and v) education. Physical environmental and device-based feedback were the most common strategies to promote physical activity after a stroke in a hospital setting. Strategies such as family presence and education improved physical activity levels, whereas device-based feedback showed mixed results. CONCLUSION Despite the importance of physical activity in early stroke, there is limited literature present to enhance activity levels. Physical environment and device-based feedback were the two most common strategies used in acute stroke survivors. The impact of these strategies remain suboptimal to be considered as effective intervention methods to enhance physical activity.
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Affiliation(s)
- Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Akhila Jagadish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Josephine Nimmy
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Heidi Janssen
- School of Health Sciences, The University of Newcastle, Australia
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Kayola G, Mataa MM, Asukile M, Chishimba L, Chomba M, Mortel D, Nutakki A, Zimba S, Saylor D. Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities. Am J Phys Med Rehabil 2023; 102:S24-S32. [PMID: 36634327 PMCID: PMC9846582 DOI: 10.1097/phm.0000000000002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke remains the second leading cause of global disability with 87% of stroke-related disability occurring in low- and middle-income countries. In low- and middle-income countries, access to acute stroke interventions is often limited, making effective poststroke rehabilitation potentially the best available intervention to promote poststroke recovery. Here, we build on our experience as an illustrative example of barriers individuals with stroke face in accessing rehabilitation services and review the literature to summarize challenges to providing effective rehabilitation in low- and middle-income countries. First, we focus on barriers individuals with stroke face in accessing rehabilitation in low- and middle-income countries, including health system barriers, such as lack of national guidelines, low prioritization of rehabilitation services, and inadequate numbers of skilled rehabilitation specialists, as well as patient factors, including limited health literacy, financial constraints, and transportation limitations. Next, we highlight consequences of this lack of rehabilitation access, including higher mortality, poorer functional outcomes, financial burden, caregiver stress, and loss of gross domestic product at a national level. Finally, we review possible strategies that could improve access and quality of rehabilitation services in low- and middle-income countries, including creation of inpatient stroke units, increased training opportunities for rehabilitation specialists, task shifting to available healthcare workers or caregivers, telerehabilitation, and community-based rehabilitation services.
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Affiliation(s)
- Grace Kayola
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Melody Asukile
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Dominique Mortel
- Department of Neurology, Johns Hopkins University School of Medicine
| | | | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine
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Moraes MDA, Mussi FC, Muniz LS, Sampaio EES, Leitão TDS, Santos CADST, Jesus PAPD. Clinical characterization, disability, and mortality in people with strokes during 90 days. Rev Bras Enferm 2021; 75:e20201383. [PMID: 34705991 DOI: 10.1590/0034-7167-2020-1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to describe clinical characteristics and mortality of people with ischemic cerebrovascular accidents (strokes); to compare disability before the event and 90 days after. METHODS longitudinal study with 308 people hospitalized in Salvador-BA. Data collection took place from 03/2019 to 01/2020. Descriptive and inferential statistics were used. RESULTS mean age was 64.8 years, and National Institute of Health Stroke Scale score was 10.7. The median length of stay in the hospital was 11 days. Afro-descendants predominated (84%), elementary educational level (68.4%), income up to three minimum wages (89.1%), arrival within 4.5 hours of symptoms (57.9%) and admission to a specialized unit (71.8%). Prevalence of thrombolysis: 26%. The asymptomatic before the event category predominated (85.3%) as did the moderate/severe disability (41.5%) after 90 days. 19.7% of the sample evolved to death. Conclusions: the high mortality and disability generated by the event have implications for health management and care.
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Kim DY, Hong DY, Kim SY, Park JJ, Kim JW, Park SO, Lee KR, Baek KJ. Prognostic value of red blood cell distribution width in predicting 3-month functional outcome of patients undergoing thrombolysis treatment for acute ischemic stroke. Medicine (Baltimore) 2021; 100:e27255. [PMID: 34664873 PMCID: PMC8447982 DOI: 10.1097/md.0000000000027255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/30/2021] [Indexed: 01/25/2023] Open
Abstract
This study was performed to determine whether red blood cell distribution width (RDW) is associated with 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.RDW was measured in patients with thrombolytic therapy in emergency department. Functional outcome was assessed after 3 months and poor functional outcome was defined as modified Rankin scale 3 to 6.A total of 240 patients were enrolled, and 82 (34.2%) had a poor functional outcome. The median RDW was significantly elevated in patients with a poor functional outcome compare with those with a good outcome. RDW was independently associated with a 3-month poor functional outcome (odds ratio 3.369, 95% confidence interval 2.214-5.125). The optimal RDW cutoff for predicting 3-month poor functional outcome was 12.8%, and the area under the curve for RDW was 0.818 (95% confidence interval 0.761-0.876). The area under the curve for RDW was higher in male patients than in female patients. The RDW correlated positively with the modified Rankin scale score after 3 months and the initial National Institutes of Health Stroke Scale score.Initial higher RDW level is related to a 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.
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Affiliation(s)
- Dae Yong Kim
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dae Young Hong
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sin Young Kim
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Won Kim
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang O. Park
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kwang Je Baek
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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Gusmão LL, Nascimento IJBD, Rocha GAS, Oliveira JADQ, Machado GSB, Antunes IDO, Sant’anna RV, Fernandes BFS, Correia UL, Ribeiro ALP, Marcolino MS. Pre-hospital Care for Suspected Stroke Patients, Cared for by Mobile Emergency Care Units in Northern Minas Gerais. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20190199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Shah B, Bartaula B, Adhikari J, Neupane HS, Shah BP, Poudel G. Predictors of In-hospital Mortality of Acute Ischemic Stroke in Adult Population. J Neurosci Rural Pract 2019; 8:591-594. [PMID: 29204020 PMCID: PMC5709883 DOI: 10.4103/jnrp.jnrp_265_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Stroke is the second most common cause of mortality worldwide. Data regarding the predictors of mortality of acute ischemic stroke are widely discordant. Identifying the predictors and providing the utmost care to a high-risk patient is still an unmet need in middle- to low-income countries. We did this study to identify the predictor of in-hospital mortality of acute ischemic stroke. Materials and Methods: We conducted a retrospective study of patients with acute ischemic stroke presented to the tertiary care center in eastern Nepal from January 2012 to December 2016. We enrolled patients of age 18 years and older with acute ischemic stroke in this study. The primary outcome of the study was in-hospital mortality of enrolled patients. Predictors of mortality were analyzed by comparing the patients with acute ischemic stroke who had mortality with those who survived. Results: The mean age of enrolled patients was 66 years. Among 257, the in-hospital mortality rate was 20.5%. The patients with in-hospital mortality had lower Glasgow coma scale (GCS) score (9 vs. 12, P < 0.001) compared to those who survived. During admission, a patient with in-hospital mortality had significantly lower arterial oxygen saturation (92 vs. 95, P < 0.001), higher pulse rate (91 vs. 83, P = 0.009), and higher respiratory rate (24 vs. 21, P < 0.001) than those patients with acute ischemic stroke who survived. Conclusion: Lower GCS score, baseline higher pulse rate, higher respiratory rate, and lower arterial oxygen saturation are the predictors of in-hospital mortality of adult with acute ischemic stroke.
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Affiliation(s)
- Bhupendra Shah
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bijay Bartaula
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Janak Adhikari
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Hari Shankar Neupane
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Birendra Prasad Shah
- Department of Anaesthesiology and Critical Care, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gunaraj Poudel
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Medeiros CSPD, Pacheco TBF, Cavalcanti FADC, Cacho RDO, Bezerra AMDS. Level of motor, sensory and functional impairment from stroke at admission and hospital discharge in Brazil. Brain Inj 2019; 33:1430-1435. [DOI: 10.1080/02699052.2019.1642515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Roberta de Oliveira Cacho
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte (UFRN), Santa Cruz/RN, Brazil
| | - Aíla Maria da Silva Bezerra
- Multiprofessional Residency in Neurology and Neurosurgery, School of Public Health of Ceará (ESP), Fortaleza/CE, Brazil
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Bacellar A, Pedreira BB, Costa G, Assis T, Lobo C, Nascimento O. Predictors of readmission and long length of stay in elders admitted with neurological disorders in a tertiary center: a real-world investigation. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:321-329. [DOI: 10.1590/0004-282x20190041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/01/2019] [Indexed: 01/27/2023]
Abstract
ABSTRACT Hospital readmission and long length of stay (LOS) increase morbidity and hospital mortality and are associated with excessive costs to health systems. Objective: This study aimed to identify predictors of hospital readmission and long LOS among elders with neurological disorders (NDs). Methods: Patients ≥ 60 years of age admitted to the hospital between January 1, 2009, and December 31, 2010, with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic factors, NDs, and comorbidities as independent predictors of readmission and long LOS (≥ 9 days). Logistic regression was performed for multivariate analysis. Results: Overall, 1,154 NDs and 2,679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8 ± 9.1). Of the patients, 54.5% were female. Patient readmissions were 251(31%) and 409 patients (51%) had an LOS ≥ 9 days (95% confidence interval 48%–55%). We found no predictors for readmission. Low socioeconomic class (p = 0.001), respiratory disorder (p < 0.001), infection (p < 0.001), genitourinary disorder (p < 0.033), and arterial hypertension (p = 0.002) were predictors of long LOS. Identified risks of long LOS explained 22% of predictors. Conclusions: Identifying risk factors for patient readmission are challenges for neurology teams and health system stakeholders. As low socioeconomic class and four comorbidities, but no NDs, were identified as predictors for long LOS, we recommend studying patient multimorbidity as well as functional and cognitive scores to determine whether they improve the risk model of long LOS in this population.
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Affiliation(s)
- Aroldo Bacellar
- D’Or Institute for Research and Education, Brasil; Universidade Federal Fluminense, Brasil
| | | | | | - Telma Assis
- D’Or Institute for Research and Education, Brasil
| | - Camila Lobo
- D’Or Institute for Research and Education, Brasil
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Baptista SCPD, Juliani CMCM, Olbrich SRLR, Braga GP, Bazan R, Spiri WC. AVALIAÇÃO DOS INDICADORES DE ÓBITO E INCAPACIDADE DOS PACIENTES ATENDIDOS EM UMA UNIDADE DE ACIDENTE VASCULAR CEREBRAL. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180001930016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar indicadores de resultado para mortalidade e grau de incapacidade dos pacientes na alta antes e após implantação da unidade de acidente vascular cerebral. Método: um estudo quantitativo, retrospectivo e transversal, realizado em um hospital público, que teve a unidade de acidente vascular cerebral implantada em 2011. Foram analisados 245 prontuários de pacientes admitidos de 29 de janeiro de 2011 a 28 de janeiro de 2012. Foram 63 pacientes nos seis meses antes da implantação da unidade de acidente vascular cerebral e 182 pacientes nos seis meses após. Utilizou-se na alta hospitalar pelos registros no prontuário a escala de Rankin modificada, possui sete graus (0 a 6) que mensura o comprometimento funcional, variando de "sem incapacidade" até "óbito". Para análise dos dados foi utilizado um software de análise estatística (SAS para Windows®, versão 9.3). Resultados: somando os indicadores 0 e 1 (sem incapacidade e ausência de incapacidade significativa) da escala de Rankin modificada, encontramos 6,72% antes e 42,86% depois da implantação, indicando condição de menor incapacidade na alta após a implantação. A mortalidade foi de 20,69% antes da implantação e 12,73% depois. Conclusão: houve redução do grau de incapacidade dos pacientes e da mortalidade após implantação da unidade de acidente vascular cerebral.
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Alhazzani AA, Mahfouz AA, Abolyazid AY, Awadalla NJ, Katramiz K, Faraheen A, Khalil SN, Aftab R. In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E927. [PMID: 29735898 PMCID: PMC5981966 DOI: 10.3390/ijerph15050927] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 11/18/2022]
Abstract
Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.
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Affiliation(s)
- Adel A Alhazzani
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia.
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt.
| | - Ahmed Y Abolyazid
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine Mansoura University, Mansoura 35516, Egypt.
| | - Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine Mansoura University, Mansoura 35516, Egypt.
| | - Khaled Katramiz
- Department of Neurology Section, Aseer Central Hospital, Saudi Arabia, Abha 21411, Saudi Arabia.
| | - Aesha Faraheen
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Shamsun Nahar Khalil
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Razia Aftab
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
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de Souza JT, Minicucci MF, Zornoff LAM, Polegato BF, Ribeiro PW, Bazan SGZ, Braga GP, Luvizutto GJ, de Paiva SAR, Bazan R, Azevedo PS. Adductor Pollicis Muscle Thickness and Obesity Are Associated with Poor Outcome after Stroke: A Cohort Study. J Stroke Cerebrovasc Dis 2018; 27:1375-1380. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 01/18/2023] Open
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13
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Lange MC, de Araujo TFS, Ferreira LFT, Ducci RDP, Novak EM, Germiniani FMB, Zetola VF. Comparing the Comprehensive Stroke Ward Versus Mixed Rehabilitation Ward-The Importance of the Team in the Acute Stroke Care in a Case-Control Study. Neurohospitalist 2017; 7:78-82. [PMID: 28400901 PMCID: PMC5382653 DOI: 10.1177/1941874416671647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is one of the most frequent causes of death in Brazil. Many measures have been taken to reduce this tragic outcome, and one of those is the implementation of stroke units in hospitals. The aim of the present study is to analyze the in-hospital complications for patients with ischemic stroke admitted in a comprehensive stroke ward (CSW) as compared to patients admitted in a mixed rehabilitation ward (MRW). METHODS A retrospective interventional study with historic controls of patients admitted to the Neurology Division between January 2010 and October 2013. Patients admitted between January 2010 and September 2012 were included in the MRW group, and patients admitted from October 2012 until October 2013 were included in the CSW group. Throughout the whole study period, the same team assisted all the patients. Both groups were paired in relation to age and gender. The rate of in-hospital complications, mortality, and independency on discharge were evaluated in both groups. RESULTS Each group was comprised of 91 patients. There were no statistically significant differences for any of the risk factors analyzed between the 2 groups nor for outcome measures-in-hospital complications, mortality, and independence on discharge. CONCLUSION The present study demonstrated that in-hospital complications, independence on discharge, and mortality have similar rates in patients admitted to an MRW compared to patients admitted to a CSW, when the same staff provided them with specialized in-hospital care. EVIDENCE LEVEL Case-control study-Evidence Level 3.
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Affiliation(s)
- Marcos C. Lange
- Neurology Division, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Tiago F. S. de Araujo
- Neurology Division, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Luiz F. T. Ferreira
- Neurology Division, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Renata D. P. Ducci
- Neurology Division, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Edison M. Novak
- Neurology Division, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Viviane F. Zetola
- Neurology Division, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Kuster GW, Dutra LA, Brasil IP, Pacheco EP, Arruda MJC, Volcov C, Domingues RB. Performance of four ischemic stroke prognostic scores in a Brazilian population. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:133-7. [PMID: 26982991 DOI: 10.1590/0004-282x20160002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 09/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ischemic stroke (IS) prognostic scales may help clinicians in their clinical decisions. This study aimed to assess the performance of four IS prognostic scales in a Brazilian population. METHOD We evaluated data of IS patients admitted at Hospital Paulistano, a Joint Commission International certified primary stroke center. In-hospital mortality and modified Rankin score at discharge were defined as the outcome measures. The performance of National Institutes of Health Stroke Scale (NIHSS), Stroke Prognostication Using Age and NIHSS (SPAN-100), Acute Stroke Registry and Analysis of Lausanne (ASTRAL), and Totaled Health Risks in Vascular Events (THRIVE) were compared. RESULTS Two hundred six patients with a mean ± SD age of 67.58 ± 15.5 years, being 55.3% male, were included. The four scales were significantly and independently associated functional outcome. Only THRIVE was associated with in-hospital mortality. With area under the curve THRIVE and NIHSS were the scales with better performance for functional outcome and THRIVE had the best performance for mortality. CONCLUSION THRIVE showed the best performance among the four scales, being the only associated with in-hospital mortality.
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