Abstract T P135: Outcome Following Stroke in a Tertiary Care Centre in South India

Abstract

OBJECTIVES: To study the demographic characteristics, risk factors, long term mortality and morbidity among patients admitted with cerebrovascular accident in a tertiary care hospital in South India. METHODS: All patients diagnosed with cerebrovascular accident, who met the inclusion criteria were enrolled into the study which was conducted between December 2011 and June 2013. Baseline demographic data, risk factors and details of the stroke were recorded. The severity of stroke in all patients was scored with the Modified Rankin score (MRS) and National Institute of Health Stroke Scale (NIHSS) at admission. MRS, details of incontinence and dysphagia were obtained at 1 month, 6 months and 1 year through telephonic communication. RESULTS: Of the 439 patients enrolled into the study, 63% were males. 90% of the patients had accessed a medical care centre within 6 hours of onset of stroke, however only 45% had accessed a medical care centre offering neuroimaging and thrombolysis facilities.93% of patients had positive findings on imaging, 74% being ischemic in etiology. Hypertension was the most common risk factor (71%). 15% of these patients were newly detected to have hypertension and 25 % of the above were normotensive at discharge from hospital. Mortality in the hospital was 11%, the most common cause being severity of the stroke itself (in the first one week) followed by aspiration pneumonia (between 1st to 4th week). At follow up, 80% of the patients could be contacted and a majority of them (95%) responded positively to the telephonic mode of communication. Mortality at the end of 1 month, 6 months and 12 months was 25%, 31.7% and 33.7% respectively. Though nearly 50% of the patients had dysphagia and incontinence at admission, during the follow up there was a trend towards improvement of both. High MRS and NIH were good predictors of mortality. NIH correlated better with mortality than MRS. CONCLUSIONS: In a developing country like India, timely access to a competent health care facility still remains a challenge. Measures to prevent aspiration pneumonia will help in reducing mortality while in the hospital. NIHS was better than MRS in predicting mortality. Telephonic communication is a good method for follow up in resource limited settings.