Trends in In-Hospital Mortality among Patients with Stroke in China

Wu, Cheng; Luo, Hong; Wang, Zhiyong; Ma, Xiaoyan; Zhao, Yanfang; Lü, Jian; Xiang, Chun; Qin, Yingyi; Wu, Shunquan; Yu, Feifei; He, Jia

doi:10.1371/journal.pone.0092763

Cited by 43 publications

(42 citation statements)

References 16 publications

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“…The mortality of ischemic stroke (7.7%) whereas that of hemorrhagic stroke was (11.7%). The overall in-hospital stroke mortality in this study was higher than that of high income countries like Germany (5.4%) [19], United States of America (6%) [20], and China (2.30%) [21]. This may be explained by difference in health seeking behavior, lack of early interventions, and stoke care unit setup differences.…”

Section: Discussioncontrasting

confidence: 54%

Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

Abdella

Gebi

Gerffie

et al. 2019

Preprint

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Background: Stroke is the leading public health problem globally. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals that showed patients increased survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: Hospital based cross sectional study was conducted from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data was collected using standardized questionnaire from secondary sources like patients medical records. Binary logistic regression were fitted to identify predictor variables. Adjusted Odds ratio(OR) with 95% confidence interval was computed and variables with p-value less than 0.05 in the multi-variable regression model considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall In-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor disability outcome at discharge was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor disability outcome at discharge. Conclusion: In-hospital mortality was lower than previous studies. However post-discharge disability is higher. Male sex, length of in-hospital stay, was significant predictors of in-hospital mortality. Increased intracranial pressure was also significant predictor of poor disability outcome at discharge. Key words: In hospital outcome, Mortality, poor outcome, stroke care unit, Gondar

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Section: Discussioncontrasting

confidence: 54%

Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

Abdella

Gebi

Gerffie

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…The mortality of ischemic stroke (7.7%) whereas that of hemorrhagic stroke was (11.7%). The overall in-hospital stroke mortality in this study was higher than that of high income countries such as Germany (5.4%) [14], United States of America (6%) [19], and China (2.30%) [20]. This may be explained by difference in health seeking behavior, professional expertise, severity of the disease, and stoke care unit setup.…”

Section: Discussioncontrasting

confidence: 53%

Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

Abdella

Gebi

Gerffie

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Epidemiological transitions and widespread risk factors made stroke common health problem in sub-Saharan countries in the early age. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals which increased patient survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: An institution based cross-sectional study was employed from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data were collected using structured questionnaire from secondary sources of patient medical records. In-hospital mortality and poor post-stroke disability (greater functional impairment, when Modified Rankin Scale score (mRS) ≥3) were outcome variables. Binary logistic regression model was fitted to identify predictor variables. Adjusted Odds Ratio (OR) with a 95% confidence interval (CI) used to assess the strength of association. Variables with p-value less than 0.05 in the multi-variable regression model was considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall in-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor post-stroke disability was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor post-stroke disability at discharge. Conclusion: Ischemic stroke was the most common stroke subtype. In-hospital mortality was relatively lower. However, greater functional impairment was high at discharge. Stroke morality was observed lower among male and longer in-hospital stay patients, while evidence of increased intracranial pressure was associated with poor post-stroke disability at discharge.

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“…Meanwhile, the in-hospital mortality was decreased from 4.1% to 1.1%, which was consistent with the findings of the previous study among ischemic stroke patients in China from 2.48% to 1.47% from 2007 to 2010. 19 Patients in the 2012 to 2013 data set were younger and had lower National Institutes of Health Stroke Scale scores, which may decrease the risk of in-hospital death. 20 Second, these improvements of in-hospital outcomes may reflect the quality improvement of in-hospital stroke care and potentially contribute to decreases in the cost of care.…”

Section: Discussionmentioning

confidence: 99%

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Wang

et al. 2016

Stroke

135

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S troke remains to be the leading cause of mortality in China and was responsible for ≈1.9 million deaths in 2013. 1 Despite advances in diagnosis and treatments for stroke, adherence to evidence-based stroke care has been suboptimal based on several national studies conducted before 2009. 2,3 Since then, improving the quality of stroke care has become Background and Purpose-Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. However, there were no significant improvements in the rates of intravenous thrombolytic therapy and anticoagulation for atrial fibrillation. After multivariate analysis, there remained a significant 1.17-fold (95% confidence interval, 1.14-1.21) increase in the odds of delivering evidence-based performance metrics in the more recent time periods versus older data. The performance metrics with the most significantly increased odds included stroke education, dysphagia screening, smoking cessation, and antithrombotics at discharge. Conclusions-Adherence to stroke performance metrics has increased over time, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China. Methods-Data

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Trends in In-Hospital Mortality among Patients with Stroke in China

Cited by 43 publications

References 16 publications

Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

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