Acute stroke in the emergency department: A chart review at KwaZulu-Natal hospital

Abstract

This study was a retrospective chart review of all patients with a clinical diagnosis of stroke presenting to an ED of a regional hospital in rural KwaZulu-Natal from November 2018 to November 2019.Results: A total of 362 patient charts were screened, and 136 of the charts met the inclusion criteria for the study. Seventy per cent of the patients had pre-existing hypertension, only one patient was not on treatment and two patients were not on secondary prevention. In human immunodeficiency virus-positive patients (20.5%; n = 28), 17 patients were under 50 years old. The most common finding on computer tomography was ischemic strokes (74%, n = 100). Thrombolysis was given to five patients included in the study. The overall in-hospital mortality rate was 4.06%. Conclusion:This study adds to the limited data about stroke in South Africa. Our population represents a unique blend of infectious and lifestyle disease. More research in this setting is recommended to develop local guidelines on emergency stroke care.

Access to acute stroke care: A retrospective descriptive analysis of stroke patients’ journey to a district hospital

“…This is much higher than reported previously in other provinces of South Africa (0.47 and 0.39 per annum), but similar to a recent study in the Western Cape that assessed the prevalence of atrial fibrillation in patients with ischaemic strokes and found the prevalence of ischaemic stroke to be 2%. [ 19 , 23 , 24 ] The proportion of ischaemic and haemorrhagic stroke was in keeping with local data and what is reported in the United States of America and Europe (85% and 11% respectively) but in contrast to data from other LMIC where the proportion of haemorrhagic stroke is reported as much higher ranging from 29-57%. [ 6 , 10 , 23 , 25 , 26 ] The median age of 62 years, is congruent with local stroke data, but much lower than the median age of 73 in HIC.…”

A descriptive study of inpatient admissions for cerebrovascular disease at a tertiary hospital in KwaZulu-Natal, South Africa

“…Although the mortality rate reported in our study (22.5%) was within the range reported in other hospital-based studies of CVD in South Africa (range: 4% -33%), (6,8) it is still alarmingly high. We attribute this high mortality rate to patient-related delays in presentation for care and poorly controlled CVD risk factors in the general population.…”

“…Patient-related delays in presenting to a hospital following a CVD event can impact the effectiveness of current treatments or the eligibility of patients for these treatments. (8,15) A recent study conducted at the Our study was not without limitations. We analysed patient data collected at a single tertiary hospital, and our findings might not be generalisable to other hospitals in South Africa.…”

“…(6) A recent chart review of 136 stroke patients from a regional hospital in KwaZulu-Natal reported a lower, but still concerning inpatient mortality rate of 4%. (8) The consequences of CVD highlight the importance of preventative efforts across the disease continuum. Primary prevention seeks to reduce the future risk of disease in individuals who are free from sub-clinical/clinical disease through health promotion and other risk reduction activities.…”

Health beliefs around stroke in an urban South African setting - a qualitative study

“…Stroke is the leading cause of morbidity, and the second leading cause of mortality in the world -responsible for 9.5% of all deaths globally (Feigin & Krishnamurthi, 2011;Lozano et al, 2012). Nearly 85% of this burden occurs in developing nations (Bham & Ross, 2005), compounded by the fact that developing countries have markedly reduced capability to support victims of stroke (Feris & Naicker, 2020). Research from South Africa shows that the local burden of stroke disease mirrors international data (Maredza et al, 2016).…”