ONSET TO HOSPITAL ADMISSION TIME AND MORTALITY IN PATIENTS WITH ISCHEMIC STROKE

Andre Dharmawan Wijono; Rizaldy Taslim Pinzon

Andre Dharmawan Wijono
Rizaldy Taslim Pinzon

Abstract

Background: The predictive factors of mortality in stroke patients are still varied and subject to debate. Lower onset to admission time have been known produces excellent outcomes with significantly lower rates of morbidity and mortality. Previous study about the onset admission time in patients with stroke ischemic in Indonesia is very limited.
Aim: Measure the correlation between onset to hospital admission time and mortality in patients with ischemic stroke.
Method: This was a retrospective cohort study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta Indonesia. A total 1657 patient with ischemic stroke were admitted between 2015-2017 and 313 patient were included in this Study adjusted by inclusion and exclusion criteria. Factors such as age, gender, onset, previous stroke, comorbidities and complications were assessed.
Result: From 313 patients with ischemic stroke, 24 patients were death. Multiple logistic regression analysis showed age (RR:3.665; 95% CI:1.147-11.711;p: 0.028) and patient with complications (RR:58.803 ; 95% CI:10.353-333.983;p: 0.000) significantly increased the risk of mortality in patient with ischemic stroke.
Conclusion: Longer onset to hospital admission time was not significantly increasing death on ischemic stroke patients. Otherwise, age and complications were persistently increasing the risk of mortality.
Keywords: ischemic stroke, onset to admission time, mortality

References

1. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007; 6:pp.182–187.
2. Krishnamurthi R, Feigin V, Forouzanfar M, Mensah G, Connor M, Bennett DA, et al. Global and Regional Burden of First-ever Ischaemic and Haemorrhagic Stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1:e259-281.
3. Centers for Disease Control and Prevention. 2013. CDC in Indonesia, Factsheet. CDC-Atlanta: Atlanta.
4. Kusuma Y, Venketasubramanian N, Kiemas LS, Misbach J. Burden of Stroke in Indonesia. Int J Stroke. 2009; 4(5): 379-380.
5. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:pp.2197-2223.
6. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and strokestatistics-2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.
7. Ebinger M, et al. Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. JAMA Neurol. 2015;72(1):25–30. 8. Jane A. Anderson, PhD. Acute Ischemic Stroke: The Golden Hour. Nursing Critical Care: May 2016 - Volume 11 - Issue 3 - p 28–36
9. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the Erly management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2013;44(3):870-947. 10. Nayak AR, Husain AA, Lande NH, Kawle AP, Kabra DP, Taori GM, et al. Impact of Admission Time on Treatment and Outcome of Stroke in Patients Admitted to Tertiary Care Hospital: A Pilot Study from Central India. J Clin Diagn Res.2015;9(6):BC01-7. 11. Heiss WD. The concept of the penumbra: can it be translated to stroke management?. Int J Stroke. 2010;5(4):290-5. 12. Paciaroni M, Caso V, Agnelli G.The concept of ischemic penumbra in acute stroke and therapeutic opportunities. Eur Neurol. 2009;61(6):321-30.
13. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-35 14. Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472-495. 15. Koton S, Tanne D, Green MS, Bornstein NM. Mortality and predictors of death 1 month and 3 years after first-ever ischemic stroke: data from the first national acute stroke Israeli survey (NASIS 2004). Neuroepidemiology. 2010;34(2):90-6.
16. Putaala J, Curtze S, Hiltunen S, Tolppanen H, Kaste M, Tatlisumak T. Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke. 2009 Aug;40(8):2698-703.
17. Das S, Ghosh KC, Malhotra M, Yadav U, Kundu SS, and Gangopadhyay PK. Short term mortality predictors in acute stroke. Ann Neurosci. 2012 Apr; 19(2): 61–67.
18. Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP. In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke. 2011 Nov;42(11):3214-8.
19. Wang J, Yu XD, and Li GQ. Comparative study on short-term and long-term prognostic determinants in patients with acute cerebral infarction. Int J Clin Exp Med. 2015;8(6):9855-61.