Abstract:
Background: Stroke is one of the commonest causes of morbidity and mortality among non communicable diseases. Its occurrence is significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia.
Objectives: The main objective of this study is to describe the clinical pattern, hospital case fatality rate and predictors of mortality in patients admitted with clinical diagnosis of stroke in University of Gondar Hospital.
Methods: Retrospective chart record analysis of adult stroke patients admitted to University of Gondar hospital medical wards from June 2009 to May 2013 was done. Sociodemographics, risk factors, clinical presentation and treatment outcomes were collected using a prepared format. Data entry, cleaning and analysis was performed using Epi-info version 7.0. Descriptive analysis was presented as frequency percentage for categorical variables and as means with SD and median with IQR for continuous variables. Group comparison was done by chisquare for categorical variables and by student t test, ANOVA or Kruskal Walis test for continuous variables. Bivariate and multivariate analyses were done when appropriate. P value < 0.05 was taken as cut off for statistically significant association.
Results: A total of 240 patients with stroke were included in the study with median age of 67.5(IQR: 57.5-75) years and M:F of 1.1:1. Ischemic stroke was the commonest type comprising 70% of the cases. Hypertension(51.5%) and atrial fibrillation(24.9%) were the most prevalent risk factors. Factors strongly associated with ischemic stroke compared to hemorrhagic were age> 65 years, atrial fibrillation, structural heart disease and diabetes while hypertension was associated with hemorrhagic stroke. The in hospital case fatality rate was 18.1% with median duration of hospital stay before death of 4 days. Factors independently associated with mortality were altered consciousness and raised intracranial pressure. There was a high rate of discharge against medical advice(30%).
Conclusion and recommendation: The number of stroke patients admitted in the hospital has increased from the past. Ischemic stroke is the most common type. Appropriate screening and treatment of hypertension and atrial fibrillation should be give due attention as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute complications; as such an emergency stroke care unit capable of managing these complications can partially decrease the death rate.
