30 - Day Outcome Of Stroke In Patients At Kenyatta National Hospital

Abstract

Background and Purpose- Stroke is the leading neurological cause of long-term disability. The goal of this study was to determine the case fatality, disability at 30days, and factors associated with outcome of stroke in a hospital cohort of stroke patients. The short-term outcome of stroke and factors affecting the outcome had not been adequately studied in our Kenyan population. Objective- To determine the 30-day outcome of acute stroke of patients admitted to Kenyatta National Hospital medical wards and Intensive Care Unit. Design -A longitudinal hospital-based study. Setting - Kenyatta National Hospital Accident and Emergency Department, Medical Wards, and Intensive Care Unit. Subjects -80 patients were recruited into the study. Sampling and follow up - the patients were sampled consecutively and the 30-day outcome of death or disability was assessed. Methods - The admission blood pressure, temperature, initial random blood sugar, HIV status, and level of consciousness were recorded. The stroke subtype was classified according to the Oxfordshire Community Stroke Project criteria. Diagnosis was done clinically and confirmed using Computer Tomography. The volume and location of intracerebral hemorrhage was assessed from the CT scan .The patients were followed up for a period of 30 days at which point the outcome of level of disability or death within 30 days of the stroke was assessed. Data management and analyses- Statistical analysis was done using statistical package for social scientists (SPSS) version 15.0, chi-square test, student's t-test, Mann Whitney U and logistic regression to determine variables associated with stroke fatality at 30 days. Results- 109 patients were screened between 5/812009 and 26111/2009.80 patients were recruited into the study with a CT scan of the brain done in 72 patients to confirm the stroke. This latter group was analyzed as a subgroup. The age range was 14years to 110years.The sex distribution was similar and the mean age of males was 56.4 years and females 58.3 years. 54.2% of the patients were admitted within a day of the stroke. The cumulative mortality at 30 days for the whole group was 45% with 60% of the deaths occurring by the ninth day after the stroke. The mean age of those who died was 65years and for those alive was 53.9 years which was statistically significant with a p=0.02. The median duration to death was 9.0 days with a mean survival time of 21.3 days. There were no differences in mortality between both sexes or stroke subtype but mortality occurred sooner in hemorrhagic stroke (at a mean number of 3 days) than in ischemic stroke (mean number 10 days ) (P=0.027). The median volume of hemorrhage for those who died was 55.6ml. 83.3% of patients with a total anterior circulation infarct died. 93.5% of the patients died in hospital. Only 14.6% ofthe patients alive at 30 days were independent when scored against the Barthel stroke score. The most significant predictors of mortality was a raised blood pressure and severe loss of consciousness at the time of the stroke. Conclusion-Stroke has a high mortality and high degree of dependency 30 days after the event. The most important determinant of mortality in this study was found to be severe loss of consciousness and elevated blood pressure at admission ..