Original Research Clinical review of stroke care at National District Hospital, Bloemfontein

Selma Smit, Dirk T. Hagemeister, Cornel van Rooyen

About the author(s) Selma Smit, Department of Family Medicine, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
Dirk T. Hagemeister, Department of Family Medicine, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
Cornel van Rooyen, Department of Family Medicine, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa

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Abstract

Background: Stroke is a leading cause of morbidity and mortality affecting sub-Saharan Africa. Studies show that dedicated stroke units improve patient outcomes. National District Hospital (NDH) manages strokes, with the potential of becoming a dedicated stroke unit in Bloemfontein, South Africa. The study aimed to describe the clinical characteristics, management and outcomes of patients presenting with stroke at NDH.

Methods: In this retrospective descriptive study, emergency department registers were used to identify patients presenting with symptoms of a stroke between 01 January 2019 and 31 March 2019. Relevant data were extracted from hospital files.

Results: Of the 106 identified patients, 53 were included in the study. The median age was 61 years (range 28–89 years), with an almost equal split between genders. The most common risk factor was hypertension (81.3%). The median time from symptom onset to presentation at NDH was 9 h. No patient received thrombolysis. One patient received neurosurgical intervention. The most prescribed secondary preventative drugs were antihypertensive medication, statins, anticoagulation and antiretroviral therapy. Half (52.8%) of the patients received rehabilitation as in-patients. Final diagnoses were ischaemic strokes (26/53, 49.0%), transient ischaemic attacks (10/56, 22.7%) and haemorrhagic strokes (6/56, 13.6%). The 6-month post-infarct mortality rate was 37.5%.

Conclusion: Patient outcomes were comparable to similar South African studies. Time delays in stroke management remain a major obstacle. Identified action points include community education, improving emergency medical services and establishing a dedicated stroke unit.

Contribution: This study underlines the importance of stroke and cardiovascular disease prevention and stresses the value of establishing dedicated stroke units.

Keywords

stroke; stroke unit; emergency stroke care; neurological outcome; thrombolysis; rehabilitation

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