Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study

James B W Russell; Elijah Charles; Victor Conteh; Durodami R Lisk

doi:10.1016/j.amsu.2020.10.060

Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study

Ann Med Surg (Lond). 2020 Nov 4:60:293-300. doi: 10.1016/j.amsu.2020.10.060. eCollection 2020 Dec.

Authors

James B W Russell^{1

2}, Elijah Charles¹, Victor Conteh^{1

2}, Durodami R Lisk^{1

2}

Affiliations

¹ Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Sierra Leone.
² Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone.

Abstract

Background: Stroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone.

Methods: This retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients' demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/with the unique identifying number researchregistry6009.

Result: We studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29-88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32-3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43-5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17-12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1-9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96-9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44-6.36), p = 0.001]. Women had poorer outcome than men.

Conclusion: This study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care.

Keywords: Mortality; Outcomes; Risk factors; Sierra Leone; Stroke.