Burden, clinical outcomes and predictors of time to in hospital mortality among adult patients admitted to stroke unit of Jimma university medical center: a prospective cohort study.
ABSTRACT: BACKGROUND:The global burden of stroke epidemiology is changing rapidly. Over the 1990-2013 periods, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of stroke varies in Ethiopia between regions and over time. Hence, this study was aimed to assess the burden, clinical outcomes and predictors of time to in hospital mortality among stroke patients. METHODS:A prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10-July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variable with P < 0.05 was considered statistically significant. RESULTS:A total of 116 eligible stroke patients were followed over 4 months. The mean age of patients was 55.1 + 14.0 years and males comprised of 73 (62.9%). Stroke accounted for 16.5% of total medical admissions. Among the 116 patients with stroke, 91 (78.4%) were discharged alive making in hospital mortality rate of 25 (21.6%). The median time of in hospital mortality and length of hospital stay after admission of the patients were 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure in 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia in 11 (44.0%) patients. Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) > 13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of time to in hospital mortality. CONCLUSIONS:The mortality rate of stroke in this setup was comparable with other low- and middle-income countries (LMICs). There is an urgent need to establish well equipped and staffed stroke units in the country in addition to strengthening the already existing one's. Furthermore, future work must be designed to identify the barriers to improve stroke outcomes and recovery.
Project description:Stroke is one of the most common medical emergencies and the leading cause of preventable death and long-term disability worldwide. A prospective cohort study was conducted at the stroke unit of Jimma university medical center for four consecutive months (from March 10 to July 10, 2017). Of the total 116 study patients, 60 (51.7%) had an ischemic stroke. At 30-day follow-up, 81 (69.8%) patients were alive, 34 (29.3%) were died, and one patient (0.9%) was lost to follow-up. Elevated alanine aminotransferase (ALT) level (AHR: 3.77, 95% CI: 1.34-10.57), diagnosis of stroke clinically alone (AHR: 3.90, 95 CI: 1.49-10.26), brain edema (AHR: 4.28, 95% CI: 1.61-11.37), and National Institute of Health Stroke Scale (NIHSS) ? 13 during hospital arrival (AHR: 6.49, 95% CI: 1.90-22.22) were the independent predictors of 30-day mortality. At 60-day follow-up, 68 (58.6%) patients were alive, 46 (39.7%) were died, and 2 (1.7%) were lost to follow-up. Discharge against medical advice (AHR: 6.40, 95% CI: 2.31-17.73) and severe modified Rankin score/mRS (4-5) at discharge (AHR: 3.64, 95% CI: 1.01-13.16) were the independent predictors of 60-day mortality. The median (IQR) length of survival after hospital admission for patients died within 30 and 60 days were 4.65 (2.34-11.80) and 9.3 (3.93-33) days, respectively. Stroke significantly affects the morbidity and mortality in Ethiopia. There is a need to provide better care and future planning for stroke patients as an emergency diagnosis and treatment to minimize mortality and disability.
Project description:Introduction:Ischemic stroke is the third leading cause of mortality in low-income countries and the sixth in Ethiopia. The aim of this study was to determine the rate and predictors of in-hospital mortality due to ischemic stroke in Gondar University Hospital. Methods:The study was conducted from April 1, 2017, to May 15, 2017, at Gondar University Hospital. A census using retrospective cohort study design was conducted on medical records of adult patients with the diagnosis of ischemic stroke attending the medical inpatient ward of Gondar University Hospital between November 2012 and September 2016. Cox hazard regression was used to determine the predictors of in-hospital mortality. A two-sided statistical test at 5% level of significance was used. Results:The mean (±SD) duration of hospital stay was 11.55 (10.040) days. Of the total 208 patients, 26 (12.5%) patients died in the hospital. Cox regression revealed that only a decrease in renal function, particularly elevated serum creatinine (AHR=8.848, 95% CI: 1.616-67.437), was associated with a statistically significant increase of in-hospital mortality. The symptom onset-to-admission time varied greatly among patients and ranged from 1 hour to 168 hours. Conclusion:The in-hospital mortality associated with ischemic stroke was found to be high. Mainly, elevation in serum creatinine was highly associated with poorer outcomes in terms of in-hospital mortality. Much work should be done on improving the knowledge and awareness of the community regarding ischemic stroke and stroke in general to encourage early medical seeking behavior and reduce mortality and long-term disability.
Project description:AIMS:The objective of this descriptive study was to compare time to medical evaluation, intravenous tissue plasminogen activator (IV tPA) use, and short-term outcomes in illicit drug users compared to non-users presenting with acute ischemic stroke (AIS). STUDY DESIGN:This is a retrospective study performed from our stroke registry using deidentified patient information. PLACE AND DURATION OF STUDY:Tulane Medical Center Primary Stroke Center (PSC). Consecutive AIS patients presenting to our PSC from July 2008 to December of 2010 were identified from our prospectively collected stroke registry. METHODOLOGY:Patients were categorized as toxicology positive (TP) or toxicology negative (TN). We compared baseline characteristics, clinical presentation, tPA use, and short-term outcomes in TP and TN patients. RESULTS:Two hundred and sixty-three patients met inclusion criteria (median age 63, 35.4% female, 66.5% Black). Nearly 40% of toxicology screens were positive. Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; however, a higher proportion of TN patients were treated with IV tPA (32.1% vs. 21.2%). After adjustment for time from last seen normal to emergency department arrival (LSN-to-ED arrival), the odds of being treated with tPA for TP patients were similar to TN patients (OR 0.69, 95% CI 0.36-1.31, p=0.255). After adjustment for age, NIHSS, glucose, and tPA, the odds of in-hospital mortality in TP patients was 3 times that of TN patients (OR 3.17, 95% CI 1.07-9.43, p=0.038). CONCLUSION:We found that the disparities observed in tPA use were attenuated after adjustment for time from LSN-to-ED arrival, suggesting an area for future intervention. Additionally, we found that TP patients may be at higher risk for in-hospital mortality. Further study on the role of substance abuse in time to ED arrival, tPA use, and outcome in AIS patients is warranted.
Project description:Colorectal cancer is one of the commonest cancer types that has a great public health impact both in developed and developing countries. However, in Ethiopia, the survival status of colorectal cancer patients was not well understood. Therefore, the aim of this study was to determine the survival status and predictors of mortality among colorectal cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. The institution-based retrospective follow-up study was conducted with 621 subjects who were selected from patients registered between January 1, 2013 and December 30, 2017 with follow-up until December 30th, 2018. Data were collected from patient record review charts. A Kaplan–Meier analysis with a log-rank test, and bivariate and multivariable analysis using the Cox proportional hazard model were used. Of the 621 colorectal cancer patients who were included in the analysis, 202 (32.5%) died. The overall mortality rate was 20.3% per year (95% CI: 17.7-23.3). The overall survival was 18.1% with median survival time of 34.8 months (95% CI: 30.4-36.8). Comorbidity (adjusted hazard ratio [AHR] = 1.8, 95% CI: 1.3-2.5); stage (II [AHR = 3.8, 95% CI: 1.3-11.1], III [AHR = 8.0, 95% CI: 2.8-23.3], IV [AHR = 17.6, 95% CI: 6.1-50.7]); smoking (AHR = 1.6, 95% CI: 1.1-2.3); alcohol consumption (AHR = 1.5, 95% CI: 1.07-2.2); age ? 70 (AHR = 1.7, 95% CI: 1.02-2.9); and marital status (married [AHR = 2.4, 95% CI: 1.5-3.8], widowed [AHR = 2.4, 95% CI: 1.2-4.6], divorced [AHR = 2.0, 95% CI: 1.1-3.7]) were significant predictors of colorectal cancer mortality. It is crucial to implement early detection and screening, giving priority to rural dweller, comorbid patients and advanced stage diagnosed patients.
Project description:OBJECTIVE:To determine the incidence and predictors of mortality among children admitted to the paediatric intensive care unit (PICU) at the University of Gondar comprehensive specialised hospital, northwest Ethiopia. DESIGN:A single-centre prospective observational cohort study. PARTICIPANTS:A total of 313 children admitted to the ICU of the University of Gondar comprehensive specialised hospital during a one-and-a-half-year period. MEASUREMENTS:Data were collected using standard case record form, physical examination and patient document review. Clinical characteristics such as systolic blood pressure, pupillary light reflex, oxygen saturation and need for mechanical ventilation (MV) were assessed and documented within the first hour of admission and entered into an electronic application to calculate the modified Pediatric Index of Mortality 2 (PIM 2) Score. We fitted the Cox proportional hazards model to identify predictors of mortality. RESULT:The median age at admission was 48 months with IQR: 12-122, 28.1% were infants and adolescents accounted for 21.4%. Of the total patients studied, 59.7% were males. The median observation time was 3?days with (IQR: 1-6). One hundred and two (32.6%) children died during the follow-up time, and the incidence of mortality was 6.9 deaths per 100 person-day observation. Weekend admission (adjusted HR (AHR)=1.63, 95%?CI: 1.02 to 2.62), critical illness diagnoses (AHR=1.79, 95%?CI: 1.13 to 2.85), need for MV (AHR=2.36, 95%?CI: 1.39 to 4.01) and modified PIM 2 Score (AHR=1.53, 95%?CI: 1.36 to 1.72) were the predictors of mortality. CONCLUSION:The rate of mortality in the PICU was high, admission over weekends, need for MV, critical illness diagnoses and higher PIM 2 scores were significant and independent predictors of mortality.
Project description:BACKGROUND AND PURPOSE:Factors associated with early arrival may vary according to the characteristics of the hospital. We investigated the factors associated with early hospital arrival in two different stroke centers located in Korea and Japan. METHODS:Consecutive patients with ischemic stroke arrived hospital within 48 hours of onset between January 2011 and December 2012 were identified and the clinical and time variables were retrieved from the prospective stroke registries of Severance Hospital of Yonsei University Health System (YUHS; Seoul, Korea) and National Cerebral and Cardiovascular Center (NCVC; Osaka, Japan). Subjects were dichotomized into early (time from onset to arrival ?4.5 hours) and late (>4.5 hours) arrival groups. Univariate and multivariate analyses were performed to evaluate factors associated with early hospital arrival. RESULTS:A total of 1,966 subjects (992 from YUHS; 974 from NCVC) were included in this study. The median time from onset to arrival was 6.1 hours [interquartile range, 1.7-17.8 hours]. In multivariate analysis, the factors associated with early arrival were atrial fibrillation (Odds ratio [OR], 1.505; 95% confidence interval [CI], [1.168-1.939]), higher initial National Institute of Health Stroke Scale scores (OR, 1.037; 95% CI [1.023-1.051]), onset during daytime (OR, 2.799; 95% CI [2.173-3.605]), and transport by an emergency medical service (OR, 2.127; 95% CI [1.700-2.661]). These factors were consistently associated with early arrival in both hospitals. CONCLUSIONS:Despite differences between the hospitals, there were common factors related to early arrival. Efforts to identify and modify these factors may promote early hospital arrival and improve stroke outcome.
Project description:Ischemic stroke, hemorrhagic stroke, and acute myocardial infarction (AMI) are diseases with golden hour. This study aimed to identify and compare factors that affect in-hospital mortality in patients with stroke and AMI who admitted via the emergency department.This study used the Korean National Health Insurance claims data from 2002 to 2013. The study sample included 7693 patients who had an ischemic stroke, 2828 patients who had a hemorrhagic stroke, and 4916 patients with AMI who were admitted via the emergency departments of a superior general hospital and general hospital, did not transfer to another hospital or come from another hospital, and were aged ≥20 years. This study was analyzed by using Cox's proportional hazards frailty model.Five hundred (6.5%) of 7693 patients with ischemic stroke, 569 (20.1%) of 2828 patients with hemorrhagic stroke, and 399 (8.1%) of 4916 patients with AMI were dead. The clinical factors were associated with in-hospital mortality such as age, CCI, hypertension, and diabetes of patient characteristics. In treatment characteristics, performing PCI and weekday admission was associated with in-hospital mortality (aHR, 0.43; 95% CI, 0.27-0.67; aHR, 1.42; 95% CI, 1.14-1.77, respectively). In hospital characteristics, the volume, the proportion of transferred patient to other hospital and ratio of beds per one nurse was associated with in-hospital mortality.Clinical factors of patient characteristics, intervention such as performing PCI and reducing ICP of treatment characteristics, and the volume, transferred rate, and the number of nurse of hospital characteristics were associated with in-hospital mortality.
Project description:Background:Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods:Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log r?ank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P? 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results:A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). Conclusion:The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.
Project description:Tuberculosis (TB) is the leading cause of death in Human immunodeficiency virus (HIV) infected children globally. The aims of this study were to determine the mortality rate and to identify the predictors of mortality among TB/HIV co-infected children at University of Gondar Comprehensive Specialized Hospital.A retrospective follow-up study was conducted among TB/HIV co-infected children from February 2005 to March 2017. A Kaplan-Meier curve was used to estimate the median survival time. Bivariate and multivariable Cox proportional hazards models were fitted to identify the predictors of mortality.A total of 271 TB/HIV co-infected children were included in the analysis. Of these, 38(14.02%) children were died during the follow-up period. This gives a total of 1167.67 child-years of observations. The overall mortality rate was 3.27(95%CI: 2.3-4.5) per 100 child-years. The independent predictors of time to death were age 1-5 years (as compared to age <1 year) (AHR = 0.3; 95%CI:0.09-0.98)), being anemic (AHR = 2.6; 95%CI:1.24-5.3), cotrimoxazole preventive therapy(CPT) non-users (AHR = 4.1; 95%CI:1.4-16.75), isoniazid preventive therapy(IPT) non-users (AHR = 2.95; 95%CI:1.16-7.5), having extra pulmonary tuberculosis(EPTB) (AHR = 2.43; 95%CI:1.1-5.3)) and fair or poor adherence to Anti-Retroviral Therapy (ART)(AHR = 3.5; 95%CI:1.7-7.5).Mortality rate among TB/HIV co-infected children was high at University of Gondar Comprehensive Specialized Hospital. Age, extra-pulmonary tuberculosis, anemia, adherence, CPT and IPT were the independent predictors of mortality.
Project description:BACKGROUND AND PURPOSE:Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). METHODS:Among 73?712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ?5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis. RESULTS:We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus ?3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster door-to-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were independent predictors of thrombolysis administration. CONCLUSIONS:Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke.