A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with Stroke: A developing state scenario

Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females) of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics) with mean (SD) age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002)], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516), sex (p=0.460), number of episodes (0.795), underlying hypertension (p=0.905). Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004), in patients with right-sided compared with left-sided hemiplegic (p=0.029) and who couldn’t afford computed tomography (CT) scan (p=0.007). Kaplan Meier curve in Image-1 shows the survival following admission to emergency ward. Conclusion: Adequate measures need to be taken to improve the public awareness of stroke and the role of local doctors. Our study has shown that active smokers, involvement of the right side and non performance of CT were independent predictors of mortality which have not been shown earlier. Also, we found that diabetes mellitus is independent predictor of mortality in stroke, which has been seen in earlier studies too

A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with stroke: A developing state scenario

Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females) of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics) with mean (SD) age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002)], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516), sex (p=0.460), number of episodes (0.795), underlying hypertension (p=0.905). Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004), in patients with right-sided compared with left-sided hemiplegic (p=0.029) and who couldn’t afford computed tomography (CT) scan (p=0.007). Kaplan Meier curve in Image-1 shows the survival following admission to emergency ward. Conclusion: Adequate measures need to be taken to improve the public awareness of stroke and the role of local doctors. Our study has shown that active smokers, involvement of the right side and non performance of CT were independent predictors of mortality which have not been shown earlier. Also, we found that diabetes mellitus is independent predictor of mortality in stroke, which has been seen in earlier studies too

A comparative study of frequency of postnatal depression among subjects with normal and caesarean deliveries

Background: The prevalence of postnatal depression (PND) is 12-15%. Recent studies are equivocal about the earlier inference that PND is higher among caesarian than normal delivery. Objective: The aim of this study is to investigate the frequency of PND among the Indian women and the association between the mode of delivery and PND. Material and method: Fifty subjects each; having delivered normally and by caesarian section was chosen. All the women were within 3 months post delivery and could understand Kannada language. Those who consented were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Those found to have scores suggestive of depression on EPDS were assessed for depression according to ICD-10. The data was analyzed using paired t test and chi square test. Result and conclusion: Among Post caesarean subjects, depression was diagnosed in 20% (n=10) as compared to 16% (n=8) in subjects that delivered normally. However there was no significant difference in the frequency of depression among the two groups. Due to the small sample size the results cannot be generalized