Medical complications and mortality of hospitalized stroke patients (original) (raw)
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Introduction: Strokes are serious neurovascular pathologies and constitute a public health problem due to their high frequency and high mortality rate. The research aim was to assess the prognostic factors of stroke in the intensive care unit of the National University Hospital Hubert Koutoukou Maga (CNHU-HKM) of Cotonou. Materials and Methods: This was a cross-sectional, descriptive and analytical research with retrospective data collection. It took place in the intensive care unit of the CNHU/HKM at Cotonou over a period of 30 months from January 1, 2015 to June 30, 2017. The cases of stroke confirmed by a brain scanner/ MRI were included. Results: A total of 109 stroke cases were included in our research and the prevalence was 5.5%. Hemorrhagic strokes were more representative (59.6%). The mean age was 59 ± 14 years, the sex ratio was 1.22. The HBP was the most common risk factor (81.7%). Mortality was 80.07% and Anesth Crit Care 2020; 2 (1): 001-007 Anesthesia and Critical Care 2 length of stay 8 ± 9 days. The poor prognostic factors were GCS ≤ 8, the presence of neurological and respiratory complications or sepsis. Conclusions: Strokes in intensive care unit at CNHU/HKM are burdened with a high mortality rate (80.07%). The poor prognostic factors were GCS ≤ 8, the presence of neurological and respiratory complications or sepsis.
Factors associated with death and predictors of Coma in a tertiary hospital in Nortwestern Nigeria
Background: Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution. Materials and Methods: In this prospective observational study, adults with clinically confi rmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients' death or survival. Results: A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed signifi cant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma. Conclusion: The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.
Abstract: Coma represents a serious, life-threatening medical condition which should be treated effectively. It is important to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7. Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate (malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2 (25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate. Keywords: Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome
Background: Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution. Materials and Methods: In this prospective observational study, adults with clinically confi rmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients' death or survival. Results: A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed signifi cant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma. Conclusion: The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.
Etiology and outcome of medical coma in a tertiary hospital in Northwestern Nigeria
Annals of Nigerian Medicine, 2012
Background: Medical coma is a common cause of admission in emergency unit, medical wards and intensive care unit. A better understanding of causes and outcome, especially in a resource poor setting, is key to planning and improving rational approach to the management of medical coma. The study was undertaken to evaluate common etiologies and outcome of non-traumatic coma among adult patients in a tertiary hospital in Kano, Northwestern Nigeria. Materials and Methods: In this prospective observational study, adults patients in coma admitted to medical emergency unit of the Aminu Kano Teaching Hospital (AKTH), over a period of 19 months, were consecutively recruited. Etiology of coma was determined on the basis of history, clinical examination, relevant laboratory and radiological investigations. Outcome, over one month was recorded. Functional outcome of the survivors was assessed with Glasgow Outcome Scale. Results: A total of 194 (140 males, 54 females) patients constituting 8.1% of all medical emergencies seen during the study period were recruited. GCS at presentation was 8 in eight (4.1%) patients, 7 in thirty (15.5%) patients, 6 in fifty eight (29.9%) patients, 5 in forty (20.6%) patients, 4 in 34 (17.5%) patients, and 3 in twenty four (12.4%) patients. Etiologies identified were infections (28.9%), toxic and metabolic causes (28.9%), and stroke (23.7%). Mortality was 49%. When compared with infective causes of coma as a whole, more deaths were recorded from strokes than infections (28/46 and 24/56 respectively), however, the difference was not statistically significant (p = 0.070) with OR of 1.4, 95% CI (0.97-2.08). There was a statistically significant difference (p = 0.023) between patients with admission GCS of 3-5 and 6-8. Conclusion: Stroke, sepsis, diabetic emergencies and chronic kidney diseases were the most common etiologies of medical coma. Outcome of medical coma was comparable to what obtains in other places in the developing countries.
Coma is a frequent diagnostic and therapeutic emergency. The aim of the study was to enumerate the etiologies of comas and to determine the prognosis of patients. It was a descriptive, cross-sectional study with prospective data collection from 1er May to 31 December 2021, i.e. a period of 8 months in the polyvalent intensive care unit of Zinder National Hospital. The parameters studied were sociodemographic aspects, admission conditions, clinical status on admission, paraclinical data, etiologies of comas, complications, patient outcome. During the study period, 830 patients were admitted, including 112 cases of coma, representing a frequency of 13.5%. The average age was 41.64±22.54 years, with extremes of 3 and 90 years. Males predominated, with a sex ratio of 1.5. Housewives were the most affected (33.9%). High blood pressure was the most frequent antecedent condition. In 66.9% of cases, onset was abrupt, and 47.3% of patients were admitted within 24 hours of coma. The Glasgow score on admission was between 6 and 8 in 47.3% of cases. Traumatic comas accounted for 36.4% of cases, followed by metabolic comas (24.8%) and vascular comas (22.2%). The average length of stay was 5 days. Overall mortality was 48.2%. Poor prognostic factors were: age over 60 (P<0.01), history of hypertension (P=0.02), respiratory distress (P<0.01), tachycardia (P<0.01), coma depth (P<0.01) and hospital stay of less than 3 days (P=0.02). Patients' prognosis depends on early and appropriate management.
SAGE Open Medicine
Objective: To assess the in-hospital mortality of acute stroke and determinant factors in a teaching hospital in eastern Ethiopia. Method: A retrospective review of medical records of patients admitted to Hiwot Fana Specialized University Hospital was conducted. Adult patients aged 18 years and older with a diagnosis of either ischemic or hemorrhagic stroke were included. Data were analyzed using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). Multiple logistic regression analysis was used to identify predictors of in-hospital mortality. Result: A total of 112 patients with acute stroke were included in the study and 56.0% of them were of hemorrhagic stroke. The mean age was 60.32 years and 61.6% were male. The mean length of hospitalization and the mean time of presentation from symptoms onset were 4.85 days and 33.64 h, respectively. The in-hospital mortality was 36.8% for ischemic stroke and 27% for hemorrhagic stroke. Aspiration pneumonia (35.0%), cerebral edema (17%), and seiz...
Risk Factors, Clinical Pattern and Outcome of Stroke in a Referral Hospital, Northwest Ethiopia
Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases. Its occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1 were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world. Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can partially decrease the death rate. Keywords: Cerebrovascular Accident,
Stroke mortality in intensive care unit from tertiary care neurological center
JNMA; journal of the Nepal Medical Association
Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by six months, and a half by one year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, Intensive Care Unit has remained the choice for stroke patients' care in developing countries. This study explores the mortality of stroke patients in ICU setting in tertiary care neurological centre in a developing country. We collected data of stroke patients admitted in our ICU from August 2009 to August 2010 and analyzed. Total 44 (10.25%) patients were admitted for acute stroke. Age ranged from 17-93 years. Low Glasgow Coma Scale (GCS), uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3%) patients had hemorrhagic stroke and 21 (47.7%) patients had ischemic stroke. Total 13 (29.54%) patients of stroke die...