CO-ORDINATED MULTI-DISCIPLINARY TEAM CARE IMPROVES ACUTE STROKE OUTCOMES IN RESOURCE LIMITED SETTINGS; FINDINGS OF A RETROSPECTIVE STUDY FROM A NIGERIAN TERTIARY HOSPITAL.

Abstract

<h3>Background</h3> Evidence for the impact of coordinated stroke multidisciplinary teams (MDTs) on outcomes in Africa is sparse. <h3>Aim</h3> To compare stroke outcomes, before and after the establishment of a pioneer MDT (September 16, 2016) at a tertiary hospital in southern Nigeria. <h3>Methods</h3> Using a retrospective, observational study design, the in-patient register of all stroke patients admitted between September 2014 to September 2018 was retrieved and rigorously reviewed. 155 patients seen 2 years before the MDT were compared with 169 stroke patients seen 2 years after the MDT. Stroke severity at admission and functioning at discharge were assessed using the Stroke Levity Scale (SLS) and the modified Rankin scale (mRS). <h3>Results</h3> Mean ages (in years) were 60 pre-MDT vs 59.57 post MDT (p=0.754). There were more males, 51% pre-MDT vs 54.2% post MDT (p=0.565). SLS and mRS were not significantly different; severe SLS and mRS pre-MDT, 52.9% vs post-MDT, 49.4% (p=0.727) and pre-MDT 19.4% vs post-MDT 19.5% (p=0.685) respectively. More post-MDT patients were discharged alive, pre-MDT,56.8% vs 79.2% post MDT (p<0.001); had swallow tests, pre-MDT 9.23% vs post-MDT 33.5% (p<0.001); on secondary prevention, pre-MDT 67.7% vs post-MDT 78.9% (p=0.023); had 4 clinic visits, pre-MDT,0.7% vs post-MDT 38.3% (p<0.001). MDT was independently associated with lower in-hospital mortality on multivariable regression, adjusted odds ratio (OR) (95% Confidence interval CI) 0.17 (0.09-0.32). <h3>Conclusion</h3> Our results suggest that a coordinated MDT may improve acute outcomes and reduce mortality in resource constrained settings where there may be no stroke units. These findings need further prospective validation.