A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in...

Area of Science:

• Neurology
• Public Health
• Spatial Epidemiology

Background:

• Significant spatial variations persist in emergency medical services (EMS) transport delays, stroke incidence, and outcomes despite advances in stroke care.
• Investigating geographical variations in in-hospital stroke mortality and associated factors is crucial.

Purpose of the Study:

• To investigate geographical variations in in-hospital stroke mortality in Mashhad.
• To identify factors associated with in-hospital stroke mortality.

Main Methods:

• Historical cohort study of suspected stroke cases transferred by EMS to Ghaem Hospital from March 2018 to March 2019.
• Integration of pre-hospital emergency data with patient medical records using emergency mission IDs.
• Bayesian approach for estimating model parameters.

Main Results:

• Out of 301 stroke patients, 61 (20.3%) experienced in-hospital mortality.
• Age, EMS access rate, arrival time (evening vs. day shift), and sequelae significantly associated with in-hospital stroke mortality (P<0.05).
• In-hospital stroke mortality was higher in central urban areas compared to suburban areas.

Conclusions:

• Marked regional variations in in-hospital stroke mortality were observed in Mashhad.
• Age directly correlated with in-hospital stroke mortality.
• Improving hypertension control, preventing sequelae, enhancing EMS access, and optimizing shift schedules can improve stroke mortality prognosis.