Managing acute ischaemic stroke in a small island developing state: meeting the guidelines in Barbados

Abstract

BackgroundWe describe hospital-based management of acute ischaemic stroke patients in 2010–2013 in Barbados, by comparing documented treatment given in the single tertiary public hospital with international guideline recommendations.MethodsEvidence-based stroke management guidelines were identified through a systematic literature search. Comparisons were made between these guidelines and documented diagnostic practice (all strokes) and prescribed medication (ischaemic stroke only), using a combination of key informant interviews and national stroke registry data for 2010–2013.ResultsSeveral published international guidelines for the acute management of ischaemic stroke recommended patient management in a dedicated stroke unit or nearest hospital specialised in stroke care. Further, patients should receive clinical diagnosis, CT brain scan, specialist evaluation by a multidisciplinary team and, if eligible, thrombolysis with alteplase within 3–3.5 h of symptom onset. Subsequent secondary prophylaxis, with a platelet aggregation inhibitor and a statin was advised.Barbados had no stroke unit or stroke team, and no official protocol for acute stroke management during the study period. Most of the 1735 stroke patients were managed by emergency physicians at presentation; if admitted, they were managed on general medical wards. Most had a CT scan (1646; 94.9%). Of 1406 registered ischaemic stroke patients, only 6 (0.4%) had been thrombolysed, 521 (37.1%) received aspirin within 24 h of admission and 670 (47.7%) were prescribed aspirin on discharge.ConclusionsAcute ischaemic stroke diagnosis was consistent with international recommendations, although this was less evident for treatment. While acknowledging the difficulty in implementing international guidelines in a low-resource setting, there is scope for improvement in acute ischaemic stroke management and/or its documentation in Barbados. A stroke unit was established in August 2013 and written clinical protocols for acute stroke care were in development at the time of the study; future registry data will evaluate their impact. Our findings have implications for other low-resource settings with high stroke burden.

Barriers and Facilitators in Perioperative Antibiotic Prophylaxis: A Mixed-Methods Study in a Small Island Setting

“…Therefore, comparisons with other studies should be made with caution. In addition, results can differ from previous research because it is difficult to implement international guidelines in SIDS due to organizational differences [ 17 ].…”

Management protocols and encountered complications among stroke patients admitted to stroke unit of Jimma university medical center, Southwest Ethiopia: Prospective observational study

“…All levels of stroke care facilities should have the capability of performing or access to either a cranial computed tomography (CT scan) or magnetic resonance imaging (MRI) scan within 30 min of the order being written with experienced physicians or a radiologist to interpret the imaging reports. Patients should also receive clinical diagnosis, CT brain scan, specialist evaluation by a multidisciplinary team and protocols should be made available for rt-PA use in acute stroke [45,46].…”

Evaluation of Physicians’ Compliance With Secondary Prevention Among Ischemic Stroke Patients: A Retrospective Study

“…Several studies have shown an increase in the rehospitalization rate among IS patients caused by not adhering to the guideline recommendations for secondary stroke prevention. Studies have found a decline in the rehospitalization rate of stroke patients as they followed the guideline recommendations [6][7][8][9][10]. According to a retrospective cohort study, patients who were discharged after IS with secondary stroke prevention therapies in the short and long term will help reduce the risk of recurrent stroke [10].…”