Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit

Akhtar, Naveed; Kamran, Saadat; Singh, Rajvir; Cameron, Peter; D’Souza, Atlantic; Imam, Yahya; Bourke, Paula; Joseph, Sujatha; Khan, Raheel; Santos, Mark; Deleu, Dirk; Elzouki, Abdel‐Naser; Abou‐Samra, Abdul Badi; Butt, Adeel A.; Shuaib, Ashfaq

doi:10.1161/strokeaha.115.010552

Cited by 33 publications

(39 citation statements)

References 42 publications

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“…The mean age was 53∙07 (±12∙86) years (19–98) with 80∙0% males in keeping with the overall demographics of Qatar with a large expatriate male population. In agreement with previous studies from HGH,13–15 most patients had subcortical ‘lacunar’ stroke resulting in mild to moderate disability. The severity of stroke as measured by the admission NIHSS score was between 0–4 in 67.3% of patients and more than 16 in only 4.4% of patients.…”

Section: Resultssupporting

confidence: 92%

DHOW2 score leads to significant improvement in acute stroke care management emergency department: a prospective analysis

et al. 2019

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BackgroundDelays in transfer of patients from emergency department (ED) to stroke ward increases medical complications. We evaluate if a new risk-score ‘DHOW2’ (dysphagia, hemiplegia, observation-required, wet (incontinence) and weight) will identify high-risk patients and whether expedited admission of ‘high-DHOW2’ score patients to SW will result in fewer complications.MethodsThe DHOW2 score was designed to determine risk of complications following acute stroke. Phase I (279 patients) tested rates of complications with increasing DHOW2. Phase II (1091 patients), evaluated if early admission to the SW of high-DHOW2 patients will lead to fewer complications. Phase III (1257 patients) monitored implementation of the DHOW2 following completion of the study.FindingsMedical complications increased with higher-DHOW2 scores during all three phases; 0%–0.8% with DHOW2 of ≤3, 3.1%–6.5% with DHOW2 of 4–5 and 10.9%–14.1% with DHOW2 of ≥6 (p=<0.001). In phase II, more high-DHOW2 patients were admitted expeditiously to the SW from ED resulting in fewer complications, and fewer deaths. The odds of medical complications with DHOW2 of ≥6 was 36.8–58.3 compared with DHOW2 of ≤3. Expedited SW admission of ‘high-DHOW2 patients’ to within 8 hours reduced the development of complications to odds of 19.18–30.17 (p<0.001).InterpretationsThe DHOW2 score detects patients at risk of AS related medical complications. It is easy to implement in busy EDs where nurses can use the score to identify such patients. The risk stratification by DHOW2 and early transfer of high-scoring patients to SW is associated with significantly fewer complications.

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Section: Resultssupporting

confidence: 92%

DHOW2 score leads to significant improvement in acute stroke care management emergency department: a prospective analysis

et al. 2019

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“…Almost 98% of acute stroke patients in Qatar are admitted in the HGH. The details of the database have previously been published ( 21 , 22 ). The present study was specifically designed to evaluate the effects of the recent COVID-19 pandemic on the trends of acute stroke care in Qatar.…”

Section: Methodsmentioning

confidence: 99%

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients

Akhtar

Abid

Kamran

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Introduction : The presence of COVID-19 infection may increase the risk of thrombotic events including ischemic strokes. Whilst a number of recent reports suggest that COVID-19 associated stroke tends to be severe, there is limited data on the effects of COVID-19 in prospective registries. Patient and Methods : To determine how COVID-19 infection may affect cerebrovascular disease, we evaluated the ischemic stroke sub-types, clinical course and outcomes prior to and during the pandemic in Qatar. The Hamad General Hospital (HGH) stroke database was interrogated for stroke admissions during the last 4 months of 2019 and January-May 2020. Results : In Qatar the number of confirmed cases of COVID-19 increased from only 2 in February to 779 in March, 12,628 in April and 45,501 in May. Stroke admissions to HGH declined marginally from an average of 97/month for six pre-COVID months to 72/month in March – May. There were 32 strokes that were positive for COVID-19. When compared to non-COVID-19 stroke during the three months of the pandemic, COVID-19 patients were younger with significantly lower rates of hypertension, diabetes and dyslipidemia. COVID-19 positive patients had more cortical strokes (34.4% vs 5.6%; p= 0.001), severe disease (NIHSS >10: 34.4% vs 16.7%; p=0.001) prolonged hospitalization and fewer with good recovery (mRS 0-2: 28.1% vs 51.9%; p= 0.001). Conclusions : When compared to six pre-COVID-19 months, the number of ischemic stroke admissions during the three months of the pandemic declined marginally. COVID-19 positive patients were more likely to have a large cortical stroke with severe symptoms and poor outcome.

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“…All AS patients admitted to the Hamad General Hospital (HGH) from January 2014 to February 2019 were included in the study. Clinical information was entered prospectively in a database as previously published [18][19][20]. The hospital has a dedicated stroke ward, admits 98% of stroke patients in Qatar, and is the only center where AS treatment with intravenous thrombolysis and mechanical thrombectomy is offered.…”

Section: Methodsmentioning

confidence: 99%

“…Although a few studies from the Middle East have reported on the sexual differences in the risk factor profile [16], clinical presentation, and outcome of stroke [17], to our knowledge, there is no study reporting specifically on the effect of sexual difference in major adverse cardiovascular events (MACEs). We have previously reported on the risk factors, clinical presentation, and outcome following AS in a diverse group of patients in Qatar [18][19][20][21]. The purpose of the study was to evaluate the short-term prognosis and long-term outcome in MACEs in Qatari nationals admitted with acute stroke (AS).…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

et al. 2020

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Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

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Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit

Cited by 33 publications

References 42 publications

DHOW2 score leads to significant improvement in acute stroke care management emergency department: a prospective analysis

DHOW2 score leads to significant improvement in acute stroke care management emergency department: a prospective analysis

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

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