Factors Associated With Presentation Of Stroke At The Emergency Departement Muhimbili National Hospital.

Abstract

Background: Stroke is among the most common causes of mortality and the leading cause of adult long-term disability. Early recognition and provision of appropriate interventions have been shown to improve the outcomes in most high-income countries. Aim: To determine factors associated with presentation among suspected stroke patients presenting to the emergency department, Muhimbili National Hospital. Methods: This was a prospective cross-sectional study with consecutive recruitment of all adults with suspected stroke presenting to the Emergency department of Muhimbili National Hospital for 3 months. Patients were identified using the ROSIER Scale i.e patients who had at least 1 point in the Rosier scale were recruited documented referral diagnosis of stroke, or evidence of stroke on the CT Head or MRI Brain. Care givers were interviewed about their knowledge of stroke symptoms and pathway from onset of symptoms until presentation to the EMD. Patient’s clinical details were obtained from the hospital. Descriptive statistics (Median and Interquartile Range) were calculated, student’s T Test and Mann Whitney were used to compare continuous variables. Odds ratios were calculated as a measure of association between exposure and outcome. Results: Among 350 patients presenting to the emergency department with suspected stroke, we recruited 324 (92.3%) patients of which 166(51.2%) were male and overall median age was 63Years (IQR 53-73 Years.). 305 (94.2%) patients presented to the EMD later than the recommended time window for thrombolysis (4.5Hours) and 5.9% of patients presented within 5Hours. Care givers who had poor knowledge on stroke symptoms had a higher likelihood of late presentation to the EMD (OR 2.48, 95% C.I 1.29 – 4.79). Similarly, patients who were referred from outside facilities were more likely to present late to the EMD (OR 8.09, 95% C.I 3.63 – 18.02). And patients residing outside Dar es Salaam were 3.5 times more likely to present late to the EMD (O.R 3.56, 95% C.I 1.24 – 10.18) vi Conclusion: Majority of patients with acute stroke present to the EMD of a national hospital later than the recommended time for thrombolysis. Knowledge was found to be significant factor for delay. Other significant factors for delay were Referral Status and Residency