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Hospital-based stroke care in Ireland: results from one regional register
C W Fan1, R McDonnell, Z Johnson
1Department of Medicine for Elderly, St. Columcille's Hospital, Dublin.
Insights
This study found high mortality and long hospital stays for acute stroke patients in South East Dublin. Improved stroke care coordination and regular audits are crucial for effective resource use.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- Acute stroke patients are typically hospitalized, necessitating data on patient profiles, management, and outcomes.
- Understanding stroke patient demographics and hospital care is vital for service improvement.
Purpose of the Study:
- To analyze the demographics, severity, diagnostic workup, length of stay, mortality, and discharge destinations of stroke admissions.
- To prospectively evaluate stroke patient data from three general hospitals in South East Dublin.
Main Methods:
- Prospective registration of 329 consecutive stroke admissions over 50 weeks using the European Stroke Database.
- Data collection included patient demographics, clinical status, investigations (CT scans, carotid Doppler), length of stay, and discharge location.
Main Results:
- The average stroke patient was 73.3 years old, with 20.1% under 65. Overall mortality was 26.1%, and mean length of stay was 31.3 days.
- 41.3% were discharged home, 15.2% to institutional care. One hospital showed a lower poor outcome rate (29.3% vs. 44.65%).
- CT scan rate was 84.5%, with 18.2% showing hemorrhage. Stroke accounted for 4.2% of total bed days.
Conclusions:
- Stroke patients in this region experience high mortality and prolonged hospitalization.
- There is a clear need for coordinated stroke care strategies and regular audits.
- Optimizing hospital resource utilization for stroke patients is essential.
Background:
Most patients with acute stroke are admitted to hospital. If stroke services in this country are to be improved, we need accurate and reliable information about the types of stroke patients being admitted, their present management and outcome.
Aims:
To examine the demography, severity, level of investigation, length of stay, mortality and discharge location of prospectively identified consecutive stroke admissions to three general hospitals in South East Dublin.
Results:
Three hundred and twenty nine consecutive stroke admissions to three general hospitals in South East Dublin were registered using the European Stroke Database over 50 weeks. The mean age was 73.3 years, whilst 20.1% patients were under 65 years. Prior to admission, 90% of patients were community dwelling with 14.9% of patients being dependent in activities of daily living. 22.4% of patients had some depression in level of consciousness on admission. The overall mortality rate was 26.1% whilst 136 (41.3%) were discharged home, 50 (15.2%) went to institutional care and 45 (13.7%) went to non general hospitals secondary rehabilitation units. The mean length of stay was 31.3 days. The combined poor outcome measure (mortality plus percentage of patients discharged to institutional care), was lower in one hospital compared to the other two hospitals (29.3% versus 44.65%, p > or = 0.05) probably reflecting case mix. Stroke accounted for 4.2% of all bed days in the major general hospital in this area. The overall CT scan rate was 84.5%, with 18.2% of CT scans showing a haemorrhagic component and two patients (0.8%) having brain tumours. Carotid doppler examinations were carried out in 37% of patients.
Conclusion:
The results demonstrate the high mortality and prolonged hospital stay for stroke patients in this area and emphasise the need for co-ordinated stroke care and regular audit to ensure most effective use of hospital resources.