- Title
- An audit of patients with new onset stroke and associated barriers to thrombolysis of hyperacute strokesat a tertiary level hospital in the Eastern Cape
- Creator
- Pasio, Roswyn Claire
- Subject
- Medicine
- Date Issued
- 2023-00
- Date
- 2023-00
- Type
- Masters theses
- Type
- text
- Identifier
- http://hdl.handle.net/11260/9891
- Identifier
- vital:74639
- Description
- Globally and in South Africa stroke is a leading cause of morbidity and mortality. In 2006, the Joint World Congress of Stroke declared stroke a ‘catastrophic illness’ in South Africa. This declaration aims to focus the attention of policymakers on the impact of stroke and engage with them to intervene. Local stroke data is needed to make informed and relevant policy changes. Data is also required to start multi-level initiatives regarding stroke prevention and care. This study aims to analyse the demographic profile of stroke and assess the quality of stroke care using time-based performance measures at Livingstone Tertiary Hospital in the Eastern Cape. Methodology The study is a descriptive, retrospective chart review of patients presenting with an acute stroke to Livingstone Tertiary Hospital Emergency Department over a 12 month period. Demographic data, stroke risk factors, patient comorbidities and mode of transport were collated and analysed. Time parameters were used to ascertain delays within the stroke care pathway of patients and factors precluding patients from thrombolysis were identified. Results The study included 403 eligible patients, 54% of the patients of whom were female. The majority of those were of Mixed-race ethnicity (49%) and aged between 50 and 79 years. Hypertension (71%) was the most common comorbidity followed by smoking (31%) and diabetes mellitus (24%). The median time from onset of symptoms to presentation to hospital was 12 hours 23 minutes (I.Q 20hrs 34min). The average time from arrival to being III seen by a doctor was 1 hour 57 minutes (I.Q 1hr 59min) and the time from arrival to radiological imaging was 17 hours 6 minutes (I.Q. 8hrs 28min). 375 patients had radiological imaging, 58% (n=217) had evidence of an ischaemic stroke compared to 21% (n=80) who had signs of an intracranial haemorrhage. Of the study cohort, 99 (25%) of all stroke patients presented within the 4.5hr thrombolytic window, 68 (32%) of which were ischaemic strokes. However, in-hospital time delays precluded 35% of these patients from thrombolysis. A further 33% of patients had other contraindications to thrombolysis and 32% were not offered thrombolysis based on the clinical discretion of the doctor. Conclusion This study highlights the burden of stroke within Port Elizabeth, located in the Western Region of the Eastern Cape. Risk factor modification and disease control is imperative in reducing the prevalence and impact of stroke. The major precluding factor in stroke patients not being offered thrombolysis is a delay in arrival to hospital. Public education and awareness initiatives need to focus on addressing this issue. The clinical discretion of the treating physician significantly influences the decision to thrombolyse patients with an acute stroke. In-service training can address physicians’ perceptions regarding the benefits of thrombolysis as a treatment option.
- Description
- Thesis (Masters) -- Faculty of Medicine and Health Sciences in brach of emergency medicine, 2023
- Format
- computer
- Format
- online resource
- Format
- application/pdf
- Format
- 1 online resource (75 pages)
- Format
- Publisher
- Walter Sisulu University
- Publisher
- Faculty of Medicine and Health Sciences
- Language
- English
- Rights
- Faculty of Commerce and Administration
- Rights
- All Rights Reserved
- Rights
- Open Access
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | Pasio PR.pdf | 1 MB | Adobe Acrobat PDF | View Details Download |