Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon

Abstract

BackgroundDespite the increasing availability of head computerized tomography (CT) in resource-limited settings, it is unclear if brain-imaging-based diagnosis of stroke affects the outcomes in the absence of dedicated structures for acute stroke management.ObjectivesIn a major referral hospital in the capital city of Cameroon, we compared in-hospital mortality rates in patients with a WHO-based diagnosis of stroke between participants with and without brain imaging on admission.MethodsStroke patients with and without admission brain imaging were compared for demographic characteristics, risk factors, clinical and laboratory characteristic, and in-hospital mortality. Heterogeneities in mortality rates (CT vs. No CT) across major subgroups were investigated via interaction tests, and logistic regressions used to adjust for extraneous factors such as age, sex, year of study, residency, history of diabetes and hypertension, history of stroke, Glasgow coma scale, and delay between stroke symptoms onset and hospital admission.ResultsOf the 1688 participants included in the final analysis, 1048 (62.1%) had brain imaging. The median age of the non-CT vs. CT groups was 65 vs. 62 years (p-value < 0.0001%). The death rate of non-CT vs. CT groups was 27.5% vs. 16.4% (p < 0.0001). This difference was mostly similar across major subgroups, and robust to the adjustments for confounders (in spite of substantial attenuation), with excess deaths in those with CT ranging from 65% to 149%.ConclusionIn this resource-limited environment, the absence of brain imaging on admission was associated with high in-hospital death from stroke, which was only partially explained by delayed hospitalization with severe disease. These results stressed the importance of scaling up acute stroke management in low- and middle-income countries.

Mortality rate and predictors of Stroke: A Meta-Analysis and Systematic Review

“…Accordingly, the pooled in-hospital mortality was found to be 16% (14%-19%). The frequency of in-hospital mortality was reported among different countries such Iran 20.52% [34] Sweden(15.47%) [19] and Cameroon 20.62% [30]. Even though hospital admission facilitates the recovery of stoke patients, in the meantime, it predisposes patients for hospital acquired infections which complicate the survival of stroke patients.…”

“…Thirty two studies assessed overall mortality due to stroke. Twelve studies were from Africa [7][8][17][18][19][20][21][22][23][24][25][26], six from Europe [27][28][29][30][31][32], six from Asia [33][34][35][36][37][38], five from North America [39][40][41][42][43] and two from Latin America [44][45].Seventeen studies reported 30-day mortality rate of stroke whereas twenty two studies measured in-hospital mortality. Detailed explanations on study characteristics are shown in the supplementary table (table 1).…”

Frequency and Mortality Risk Factors of Acute Ischemic Stroke in Emergency Department in Burkina Faso

“…We are not aware of a previous study that looked specifically at the association between time to perform brain CT on admission and in-hospital mortality for stroke in sub-Saharan Africa. Lekoubou et al in Cameroon had found that no CT performed on admission was predictor of mortality for ischemic or hemorrhagic stroke patients [29]. According to recommendations, a suspected stroke patient should have a CT within 3 hours of symptom onset to allow for appropriate intervention to arrest progression of neurological deficits [30].…”

Stroke units in Nigeria: a report from a Nationwide organizational cross-sectional survey

“…According to a survey of stroke experts, the minimum investigations required for stroke unit care were brain CT (prioritized for stroke patients), carotid Doppler, and ECG [ 38 ]. A previous study of stroke patients in a Cameroonian medical unit confirmed the importance of brain CT in mortality reduction in a resource-constrained setting [ 39 ]. Recent studies have suggested an increase in the prevalence of extracranial carotid atherosclerosis in Africans [ 40 , 41 ].…”