Pattern of admission and clinical profile of post-stroke patients in a community hospital in Najran.

troke is the third leading cause of death and the number one cause of disability in industrialized countries.1 In 2 community-based studies in the Eastern Province of Saudi Arabia, the prevalence rate for stroke was found to be 178 per hundred thousand.2 Patients who develop stroke are usually elderly and have underlying systemic disorders such as diabetes, hypertension, coronary artery disease, and so forth. After they recover partly or completely they are discharged from hospitals and follow medical or neurology departments. Many follow rehabilitation centers. Complications are common among this fragile group of post-stroke patients (PSP) and a significant number require hospital admission for various reasons. This is a retrospective study performed on PSP admitted to the hospital under the Department of Medicine in Najran General Hospital (NGH) for a period of 3 years from the start of January 2000 to the end of December 2002. Najran General Hospital is a 200 bedded community hospital catering to 13 primary health care centers. All patients who were admitted with a diagnosis of old cerebrovascular accident were included in the study. These patients were either admitted due to subsequent stroke, a post-stroke complication or an associated medical disease. Patients admitted with index stroke and those with previous head injury were excluded. The study has taken into account the number of admissions rather than the number of patients. Thus, many cases were included in the study more than once. We obtained the data from the record section of NGH. The data were tabulated and analyzed. A total of 267 PSP admissions were studied. Out of this, there were 147 (55%) male admissions and 120 (44.9%) female admissions. The age group ranged from 50-120 years (mean 70.96 ± 9.30 years). Most of the cases were between 60 and 70 years (49%) and the majority (98.1%) of the patients were Saudis. All cases were previously diagnosed to have cerebrovascular accident (stroke) and documented by computerized tomography (CT) scan of the brain. The most common type of stroke was thrombotic in 225 (84.3%) followed by hemorrhagic in 27 (10.1%), embolic in 10 (3.7%) and lacunar in 5 (1.9%). Two hundred and forty-five (91.8%) had hemiplegia; out of which 171 (69.8%) had right sided hemiplegia and S 74 (30.2%) had left sided hemiplegia. Two hundred and nineteen (82%) were aphasic or dysphasic. One hundred and ninety-five (73%) had associated supranuclear 7th nerve and other cranial nerve palsies. Common associated diseases present in these patients were diabetes (90%), hypertension (95%), coronary or rheumatic heart diseases (54%), and chronic liver disease (1.87%), deep vein thrombosis of leg veins in 3 cases and axillary vein thrombosis in one. Many were bedridden (77%) and needed a bedside attendant for care. One hundred and six (39.7%) had a nasogastric tube (NGT) for feeding purposes. One hundred and thirty (48.7%) were on an indwelling catheter and 7% on condom catheter. Many were incontinent but were using adult sized diapers. Intertrigo including candidiasis was noted in some with diapers. Diaper use was due to insistence of the attendants who feared infection due to catheters. Fourteen percent of cases with old strokes were ambulatory needing no support for activities of daily living. The main reason of their admission was for associated diseases. The earliest a patient was readmitted to the hospital after stroke was 2 weeks but the majority of the patients needed admission to the ward after approximately 3 months. There were various reasons for admission of these patients, the most common ones being infection in 198 (74.2%) especially respiratory tract infection including aspiration pneumonia in 106 (39.7%) and urinary tract infection (UTI) in 80 (30%). Thirty-two patients were admitted for bedsores (12%) out of which 12 (4.9%) were infected. Fifty-eight (21.7%) patients were admitted with a diagnosis of acute confusional state and 2 main reasons were infection and dehydration. Out of these many patients had dehydration due to a history of not taking feeds. Of these, 23 were without NGT and 35 had an NGT. Uncontrolled diabetes mellitus, hypertension, congestive cardiac failure and arrhythmias were the other factors, which brought the patients to the hospital in 9.7%, 4.9%, 4.5% and 2.2%. Subsequent stroke (second time or more) was the reason for 3% of admissions. Duration of hospital stay varied depending on the diagnosis for which patients were admitted. One hundred and fifty-six (58.4%) cases were admitted for less than 7 days, 70 (26.2%) for a period of 7-14 days and 41 (15.35%) for more than 14 days. Among patients admitted with various infections, the reason for the longest hospital stay was for infected bedsores (mean ± standard deviation (SD)) 22.92 ± 5.25 days; aspiration pneumonia and respiratory infections 9.49 ± 2.96 days whereas the shortest duration was for UTI 5.087 ± 1.058 days. Overall the mean duration of stay in the hospital was 9.12 ± 3.91 days. Outcome