Why are patients with acute stroke admitted to hospital?

Bamford, John; Sandercock, Peter; Warlow, Charles; Gray, Muir

doi:10.1136/bmj.292.6532.1369

Cited by 108 publications

(41 citation statements)

References 3 publications

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“…Additionally, physicians tend not to hospitalize older patients. 20 This practice can induce a bias observed in institutional studies that tend to include younger patients and more severe stroke cases. 7 Even though the Matão population cannot represent the whole Brazilian population in terms of lifestyles and genetic aspects, at least in age distribution the Matão population reflects the same proportion as seen in the country (Figure).…”

Section: Discussionmentioning

confidence: 99%

Stroke Incidence, Prognosis, 30-Day, and 1-Year Case Fatality Rates in Matão, Brazil

Minelli¹,

Fen²,

Minelli³

2007

Stroke

144

102

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Background and Purpose-Stroke is the main cause of death in Brazil and no prospective population-based study has been conducted in the country. The purpose of this study was to determine the incidence of stroke, stroke subtypes, case fatality, and prognosis after 1 year of follow-up in the city of Matão, Brazil. Methods-Using overlapping methods of case ascertainment, all stroke cases that occurred in the city of Matão (population, 75 053) from November 1, 2003 to October 31, 2004 were followed-up at 1 month and 1 year after the episode. Standard criteria for population-based stroke studies were followed. Results-Of 141 suspect stroke cases identified, 81 were first-ever-in-a-lifetime strokes. All patients underwent a CT scan. The crude annual incidence rate per 100 000 per year was 108 (95% CI, 85.7-134.1) and the rate adjusted for sex and age to the Segi population was 137 (95% CI, 112.0 to 166.4) per 100 000 inhabitants per year. Ischemic stroke occurred in 69 (85.2%) subjects, intracerebral hemorrhage in 11 (13.6%), and subarachnoid hemorrhage in 1 (1.2%). The 30-day case fatality rate was 18.5 and the 1-year case fatality rate was 30.9%. After 1 year of follow-up, 43% of the patients were independent in activities of daily living, 49.4% had independent gait, and 15.9% had a recurrent stroke. Conclusions-The present results are similar to those obtained in other stroke population-based studies. Future studies in Matão will provide the opportunity to discover ways to decrease the stroke burden in Brazil. (Stroke.

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Section: Discussionmentioning

confidence: 99%

Stroke Incidence, Prognosis, 30-Day, and 1-Year Case Fatality Rates in Matão, Brazil

Minelli¹,

Fen²,

Minelli³

2007

Stroke

144

102

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“…The need to relieve the family of caregiver responsibility has been found to be a reason for institutionalization of stroke patients. 30 Earlier data collection, ie, after discharge, might have revealed higher levels or other types of burden. 6,8 More research is needed on the dynamic aspects of caregiving.…”

Section: Discussionmentioning

confidence: 99%

“…In the Netherlands approximately 70% of all stroke patients are admitted to the hospital. 29 Since hospitalized patients have shown to be patients with more severe strokes, 29,30 a community-based study might have revealed lower levels of caregiving burden. Second, generalization may be affected by selection bias caused by nonresponse (52 partners, 30%).…”

Section: Discussionmentioning

confidence: 99%

The Burden of Caregiving in Partners of Long-Term Stroke Survivors

Reimer

Haan

Rijnders

et al. 1998

Stroke

215

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Background and Purpose-Few data are available on the specific caregiving-related problems of stroke patients' caregivers and factors that influence the burden of these caregivers. The aim of this study was to describe the level and specific nature of the burden of caregiving as experienced by stroke patients' partners and to estimate the relative contribution of patient and partner characteristics to the presence of partners' burden. Methods-As part of a multicenter study on quality of care, burden of caregiving was assessed in 115 partners at 3 years after stroke. Explanatory factors of burden were studied in terms of (1) characteristics of patients (sociodemographic status, severity, type, and localization of stroke, disability, handicap, and unmet care demands) and (2) characteristics of partners (age, sex, disability, quality of life, loneliness, amount of care provided, and unmet care demands). Results-Partners of stroke patients perceived most caregiving burden in terms of feelings of heavy responsibility, uncertainty about patients' care needs, constant worries, restraints in social life, and feelings that patients rely on only their care. Multiple regression analysis revealed that a higher level of burden could partly be explained by patients' disability (R 2 ϭ14%), but primarily by partners' characteristics in terms of emotional distress (R 2 ϭ16%), loneliness (R 2 ϭ6%), disability (R 2 ϭ3%), amount of informal care provided (R 2 ϭ2%), unmet demands for psychosocial care (R 2 ϭ4%), and unmet demands for assistance in activities of daily living (R 2 ϭ2%). Conclusions-Higher levels of burden are primarily related to partners' emotional distress and less to the amount of care they provided, or to patients' characteristics. Sharing responsibilities, helping to clarify the patients' needs, and getting occasional relief of caregiving may be important in the support of caregivers.

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“…Although these figures show a slight decline in the number of caregivers in the UK, they also show an increase in the number of carers providing support for 20 hours or more every week from 1.5 million to 1.7 millioa Parker (1985) estimated that one and a quarter million people living in Britain care for disabled or elderly people living in the community. It has been documented that between 10 and 50% of stroke patients are cared for at home without ever being admitted to hospital (Bamford et al, 1986;Wade and Langton-Hewer, 1985). The variability in estimates might be due to regional differences in notification systems and hospital referral or differences in the definition and diagnosis of stroke.…”

Section: Prevalence Of Informal Caregivingmentioning

confidence: 99%

Caregiver strain in spouses of stroke patients

Blake¹,

Lincoln²,

Clarke

2003

Clin Rehabil

107

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Objective: To test the ability of a previously generated logistic regression model to predict caregiver strain from carer mood, negative affectivity and perceived patient functional ability. Design: Postal prospective survey. Setting: Spouses of community-residing patients identified from hospital stroke registers. Method: Spouses were assessed at three and six months after stroke. A previously derived equation was used to make predictions at three months of their level of strain at six months, which were compared with observed outcomes. Measures: Spouses were asked to complete the Caregiver Strain Index (CSI), the General Health Questionnaire (GHQ-12), the Positive and Negative Affectivity Schedule (PANAS) and to assess patients' independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Results: Of 409 stroke patients, 276 had an identifiable co-resident spouse and 116 (42%) completed the measures. At three months after stroke, 39 carers (34%) were under significant strain with 40 (35%) under strain at six months. The predictive model using the GHQ-12, PANAS and EADL at three months was 78% accurate in predicting levels of caregiver strain at six months. Conclusion: Carers at risk of later strain could be identified for further followup. Services to provide emotional support to carers might be effective in the reduction of carer strain.

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Why are patients with acute stroke admitted to hospital?

Cited by 108 publications

References 3 publications

Stroke Incidence, Prognosis, 30-Day, and 1-Year Case Fatality Rates in Matão, Brazil

Stroke Incidence, Prognosis, 30-Day, and 1-Year Case Fatality Rates in Matão, Brazil

The Burden of Caregiving in Partners of Long-Term Stroke Survivors

Caregiver strain in spouses of stroke patients

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