Causes of mortality in patients after first-ever stroke: A retrospective population-based study

An in-hospital stroke system to optimize emergency management of acute ischemic stroke by reducing door-to-needle time

BACKGROUND

Door-to-needle time (DNT) is a critical consideration in emergency management of acute ischemic stroke (AIS). Deficiencies in the widely applied standard hospital workflow process, based on international guidelines, impede rapid treatment of AIS patients. We developed an in-hospital stroke system to reduce DNT and optimize hospitals' emergency procedures.

OBJECTIVES

To investigate the effect of the in-hospital stroke system on the hospital workflow for AIS patients.

METHODS

We performed a retrospective study on AIS patients between June 2017 and December 2021. AIS cases were assigned to a pre-intervention group (before the in-hospital stroke system was established) and a post-intervention group (after the system's establishment). We compared the two groups' demographic features, clinical characteristics, treatments and outcomes, and time metrics data.

RESULTS

We analyzed 1031 cases, comprising 474 and 557 cases in the pre-intervention and post-intervention groups, respectively. Baseline data were similar for both groups. Significantly more patients in the post-intervention group (41.11%) were treated with intravenous thrombolysis (IVT) or endovascular therapy (ET) compared with those in the pre-intervention group (8.65%) (p < 0.001). DNT was markedly improved (decreasing from 118 (80.5-137) min to 26 (21-38) min among patients in the post-intervention group treated with IVT or bridging ET. Consequently, a much higher proportion of these patients (92.64%) received IVT within 60 min compared with those in the pre-intervention group (17.39%) (p < 0.001). Consequently, their hospital stays were shorter (8 [6-11] days vs. 10 [8-12] days for the pre-intervention group; p < 0.001), and they showed improved National Institutes of Health Stroke Scale (NIHSS) scores at discharge (-2 [-5-0] vs. -1 [-2-0], p < 0.001).

CONCLUSION

DNT was significantly reduced following implementation of the in-hospital stroke system, which contributed to improved patient outcomes measured by the length of hospital stay and NIHSS scores.

Causes of mortality in patients after first-ever stroke: A retrospective population-based study

BACKGROUND

Stroke is the third most common cause of death in developed countries and it is the most common cause of disability in the adult population of Iran. In this study, we aimed to evaluate the effects of age, sex, and other predisposing risk factors on mortality after stroke.

METHODS

We studied 1572 patients with first-ever stroke during a 7-year period from January 2008 to December 2014. Patients' medical records including demographic information, past medical history, physical examination, and laboratory testing were reviewed. We analyzed the correlation of qualitative and quantitative variables with sex and mortality.

RESULTS

Of all patients, 252 (16%) died during the hospital stay and of the remaining 1320 patients, 453 (34.3%) died during the follow-up period. There was no significant correlation between mortality and sex (p = .508). Descriptively, the number of women was higher in all age groups except in the age group 55-64 years. No significant correlation was observed between sex and age group (p = .748). We also observed a significant association between age group and mortality (p < .001). Hypertension is the most prevalent disease in both men and women. Higher levels of creatinine, urea, fasting blood sugar, neutrophils, cholesterol, and LDL significantly increase and higher levels of lymphocytes, platelets, RBCs, hemoglobin, and triglyceride significantly decrease the mortality.

CONCLUSION

There are no sex differences in mortality after first-ever stroke. Elderly patients need more support and attention due to greater stroke mortality. Complete blood count, lipid profile and blood levels of urea, creatinine, and fasting blood sugar may be useful in predicting mortality after first-ever stroke.