Youkee Daniel, Deen Gibrilla, Barrett Edward, Fox-Rushby Julia, Johnson Israel, Langhorne Peter, Leather Andrew, Marshall Iain J, O'Hara Jessica, Rudd Anthony, Sama Albert, Scott Christella, Thompson Melvina, Wafa Hatem, Wall Jurate, Wang Yanzhong, Watkins Caroline, Wolfe Charles, Lisk Durodami Radcliffe, Sackley Catherine Mary
School of Population Health and Environmental Sciences, King's College London, London, United Kingdom.
College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Front Neurol. 2021 Sep 7;12:712060. doi: 10.3389/fneur.2021.712060. eCollection 2021.
Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired -tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals. Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9-25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12-26) vs. 13 (IQR 7-22) ( < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) ( < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% ( = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6-73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0-7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65-6.75), pneumonia (OR 3.75, 1.82-7.76), subarachnoid haemorrhage (OR 43.1, 6.70-277.4) and undetermined stroke types (OR 6.35, 2.17-18.60) were associated with higher risk of in-hospital death. We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.
中风是非洲成年人死亡的第二大常见原因。本研究报告了塞拉利昂弗里敦中风患者的人口统计学特征、中风类型、中风护理及住院结局。一项前瞻性观察登记研究记录了2019年5月至2020年4月期间所有18岁及以上的中风患者。中风根据世界卫生组织标准进行定义。采用Pearson卡方检验来检验分类变量之间的关联，对于连续变量采用不成对t检验。报告用于解释住院死亡情况的多变量逻辑回归分析结果为比值比（OR）和95%置信区间。共登记了385例中风患者，其中315例（81.8%）为首次发病。平均年龄为59.2岁（标准差13.8），男性187例（48.6%）。在中风患者中，327例（84.9%）经CT扫描确诊。缺血性中风231例（60.0%），脑出血85例（22.1%），蛛网膜下腔出血11例（2.9%），中风类型未确定的58例（15.1%）。就诊时美国国立卫生研究院卒中量表的中位数为17[四分位间距（IQR）9 - 25]。与缺血性中风相比，出血性中风更严重，分别为20（IQR 12 - 26）和13（IQR 7 - 22）（P<0.001），且发病年龄较轻，平均年龄分别为52.3岁（标准差12.0）和61.6岁（标准差13.8）（P<0.001），受教育程度较低，分别为28.2%和40.7%（P = 0.04）。从中风发作到抵达主要转诊医院的中位时间为25小时（IQR 6 - 73）。一半的患者（50.4%）在抵达之前曾在其他医疗机构就诊。151例患者在医院死亡（39.5%）。43例死亡发生在抵达医院后的48小时内，中位死亡时间为4天（IQR 0 - 7天）。在患者中，49.6%发生了≥1种并发症，98例（25.5%）发生肺炎，33例（8.6%）发生尿路感染。男性（OR 3.33，1.65 - 6.75）、肺炎（OR 3.75，1.82 - 7.76）、蛛网膜下腔出血（OR 43.1，6.70 - 277.4）和中风类型未确定（OR 6.35，2.17 - 18.60）与住院死亡风险较高相关。我们观察到年轻人群中发生严重中风且住院死亡率较高。开展基于证据的中风护理的进一步工作对于降低塞拉利昂的中风死亡率至关重要。
