Stroke is a cardiovascular related disease that commonly presents at the emergency department(ED) with high mortality rates and lifelong disability. At the ED, overcrowding is a reportedchallenge that has impact on the outcome of patient care. The overall aim of the study was toevaluate the levels of overcrowding and predictors of mortality outcomes among stroke patientsat the ED of Tema General Hospital (TGH) in the Greater Accra Region of Ghana, a lowermiddle income country (LMIC) in sub-Saharan Africa (SSA). The study aimed to evaluate thecrowding status of the ED, stroke specific case fatality, stroke specific mortality by strokesubtype, association between CT scan use and stroke mortality, association between admissionBP levels and mortality, and to evaluate ED overcrowding and other predictors of strokespecific mortality.This was a facility-based retrospective study of prospectively collected secondary data alreadydocumented in the patients’ clinical records between October 2019 and March 2020.Participants were all patients aged 18 years and above who presented at the ED with any focalneurologic deficit suggestive of acute stroke (ischaemic, haemorrhagic, and transient ischaemicattack). The National Emergency Department Overcrowding Scale (NEDOCS) was thestandard metric used to assess the levels of crowding. The analysis was evaluated at the 95%confidence interval and a p-value of <0.05 was considered significant. The outcome variableof interest was stroke mortality.A total of 175 (89 males and 86 females) stroke patients visited the ED during the period ofdata collection. Only 70 (40.0%) stroke patients had a computer tomography (CT) scan doneduring admission at the ED. The ED was always overcrowded with the NEDOCS greater than100. There were 139 deaths representing a stroke specific mortality rate of 79.4%. Overall,there were 104 (59.4%) ischaemic strokes of which 78 (75.0%) died, and there were 71 (40.6%)haemorrhagic strokes of which 61 (85.7%) died at the ED. There were three statisticallyxxvsignificant stroke predictors; average NEDOCS (AOR = 1.033; 95% C1: 1.003 – 1.064; p =0.033), type of stroke (haemorrhagic stroke) (AOR = 3.834; 95% CI: 1.184 – 12.416; p = 0.025)and a medical history of diabetes mellitus (AOR = 3.001; 95% CI: 1.006 – 8.951; p = 0.049).In conclusion, in-patient stroke case fatality was extremely high and stroke mortality werehigher among younger patients and patients with haemorrhagic stroke. There is an urgent needto establish comprehensive stroke care systems at the ED to reduce stroke mortality, andpractical measures to improve the crowding situation at the ED are required
