Study of the Outcome Differences among the Ischemic Stroke Subtypes basedon TOAST Classificationat Tribhuvan University Teaching Hospital, Nepal

Abstract

The objective of this study was to explore the outcome differences among is chemic stroke sub types based on “Trial of ORG 10172 in Acute Stroke Treatment (TOAST)” system in a tertiary referral hospital.
 A hospital based prospectiv elongitudinal study was conducted involving 182 patients. Modified Rank in Scale (MRS) was used to assess functional out come, Kaplan-Meierproduct- limit method and Coxproportional hazards regression analys is were used to evaluate rates and identify predictors of survival and recurrent stroke.
 MRS were statistically different across stroke subtypesat 30 days and 6 months (p<0.0001 and (p<0.0001) respectively). Lacunar stroke was associated with milder deficits. Estimated rates of recurrent stroke were significantly different at 30 days (p<0.0001) and at 6 months (p=0.009). Before adjusting forage, sex, stroke severity, and diabetes mellitus, infarct subtype was not an independent determinant of recurrent stroke within 30 days (p=0.057);but was at 6 months (p=0.024), how ever after same adjustment it was independent determinant both at 30 days (p=0.030) and at 6 months (p=0.025). Estimated death rates were significantly different both a t 3 0 days (p=0.026) and at 6 months (p=0.009). Ischemic stroke subtype was an independent determinant of 6-month survival both before (p=0.016) and after (p=0.027) adjustment for different parameters; however, was not of 30-day survival both before (p=0.054) and after (p=0.993) same adjustment.
 Early recurrencerates were highest among large artery atherosclerotic stroke. Lacunar stroke has better post stroke functional status. Survival is poorest among cardioembolic stroke.

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

“…As indicated in Table 1 , the pooled mean age was 62.4 years, ranging from 51.9 [ 38 ] to 70.5 years [ 18 ]. From 46 studies reporting data on sex distribution, 44 studies showed a higher percentage of stroke in males [ 10 , 12 – 14 , 16 , 19 – 21 , 23 – 28 , 30 – 33 , 35 – 41 , 43 – 45 , 47 – 51 , 53 – 59 , 61 – 64 ] (Table 1 ).…”

“…From 23 studies investigating aspects of acute care [ 13 , 30 , 40 , 49 ], four studies consisted of data on length of hospital stay [ 13 , 30 , 40 , 49 ], four studies highlighted complications [ 13 , 16 , 30 , 48 ], and 19 studies reported mortality [ 11 , 17 , 21 , 26 , 29 , 30 , 32 , 34 , 36 , 38 , 40 , 41 , 45 , 48 , 51 , 52 , 56 , 57 , 62 ]. 12 studies included treatment modalities [ 21 , 31 , 32 , 36 , 38 , 42 – 45 , 48 , 57 , 61 ] [ 42 , 44 , 61 ].The outcome of stroke was described in 22 studies [ 11 , 17 , 21 , 26 , 29 , 30 , 32 – 34 , 36 , 38 , 40 , 41 , 43 – 45 , 48 , 51 , 52 , 56 , 57 , 62 ], and the long-term outcome (3 months after stroke) was investigated only in seven studie...…”

“…From 13 studies reporting on the disability and functional outcome of stroke patients, ten studies used the modified Rankin scale (mRS) [ 13 , 21 , 35 , 43 – 45 , 50 , 51 , 56 , 57 ], two studies used the Glasgow outcome scale [ 32 , 36 ] and one used WHO disability assessment schedule [ 27 ]. Assessment time ranged from discharge to 6 months.…”

“…Assessment time ranged from discharge to 6 months. Most patients had mRS 3 [ 21 , 50 ], and the mean average mRS ranged from 2.66 to 3.48 [ 50 , 51 ]. Table 3 presents the disability and functional outcomes of 13 studies.…”

“…Mortality was reported in 19 studies [ 11 , 17 , 21 , 26 , 29 , 30 , 32 , 34 , 36 , 38 , 40 , 41 , 45 , 48 , 51 , 52 , 56 , 57 , 62 ]. Maximum mortality at three months was found in a study by Shrestha S et al (28.57%), while at six months, mortality was high in a study by Nepal PR et al (58.8%) [ 38 , 57 ].…”