Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

Abstract

INTRODUCTION: Stroke is one of the most important public health issues worldwide, and ranks as the second highest cause of mortality in our country. Regular follow-up of stroke statistics and taking necessary precautions upon determining deficits by countries themselves constitute the most important way of improving prognosis and survival after stroke incidents. To achieve this goal, statistical studies should be performed at various levels of healthcare services. Tertiary care hospitals are the most suitable centers to perform these studies. However, the majority of the population receives service at secondary care centers where he actual statistics remain unknown. The objective of this study was to examine all patients with acute stroke who presented to a county hospital over a one-year period and obtain related data, discuss deficits, and provide solutionbased recommendations.

METHODS: All patients diagnosed as having acute stroke between July 2013-July 2014 were included in the study. Demographic, clinical, and radiologic data, in addition to the timing of presentation and baseline National Institutes of Health Stroke Scale (NIHSS) scores were recorded retrospectively, and patients were classified by the type of stroke. All patients were followed up for at least one year after the stroke incident and cumulative survival scores were calculated using Kaplan-Meier analysis.

RESULTS: Hemorrhagic stroke was determined in four out of 49 patients with acute stroke; the 45 patients diagnosed as having ischemic stroke were included in the study. Among these, 44.4% (n=20) of the patients presented within the first three hours of onset of clinical symptoms, 4.4% (n=2) presented at 3.-4.5 hours. Baseline NIHSS was 1-4 (mild stroke) in 50% (n=10) of patients who presented in the first three hours, and >5 (moderate or severe stroke) in 50% (n=10) of the remaining patients. The etiologic cause was embolic in 37.1% (n=13), large artery atherosclerosis in 20% (n=7), small vessel disease in 8.6% (n=3), arterial dissection 2.9% (n=1), and undetermined in 31.4% (n=11) of the patients. Twenty-one patients died during follow-up. The survival rates at one, three, and twelve months were 82.2%, 57.8%, and 53.3%, respectively.

DISCUSSION AND CONCLUSION: Treatment of patients with acute stroke is more difficult at secondary care centers compared with tertiary care centers. Precautions taken in developed countries should be adapted to our country to improve stroke prognosis nationwide.