Medical and Neurological Complications among Stroke Patients Admitted for Inpatient Care in Addis Ababa, Ethiopia.

BACKGROUND AND PURPOSE Medical and neurologic complications of acute stroke adversely impact patient outcome and in some cases can be preventable. There is scarcity of data in the African medical setup and none to date in our country to our knowledge. The current study aims to describe types and frequencies of neuro-medical complications occurring in hospitalized patients after an acute stroke and to identify risk factors for development of these complications and the role of these factors on mortality. METHODS A total of 71 patients with acute stroke (excluding Sub-arachnoid Hemorrhage) who were admitted to three hospitals in Addis Ababa from June 2008 to March 2009 were included in the study. These patients were prospectively followed until their discharge or death to look for the nature and frequency of neuro-medical complications. Basic demographic data, stroke related medical information, pre-existing medical conditions, admission laboratory and imaging findings were recorded. All events were documented for each patient using pre-defined medical complication using a data collection format. Descriptive and analytic statistical tests were performed to measure associations between risk and outcome factors. RESULTS Stroke-complications were detected in 71.8% (51/71) of the study participants and the most frequent complication was aspiration pneumonia which occurred in 33.8% (24/71). Miscellaneous complications such as sepsis, hypokalemia exposure keratitis were detected in 25% (17/71) of stroke patients. Complications were more common in patients with severe neurologic deficit as measured by Glasgow coma scale (GSC) and old age. GCS < 12 and age > 40 years were both significantly associated with developments of complications after stroke (p < 0.05). A total of 17 (23%) patients died during their in-patient stay. GCS < 12 was significantly associated with mortality related to stroke in the admitted patients (p = 0.0002) while there was no association between old age and mortality. CONCLUSIONS Complications after stroke are common and are major factors contributing to mortality. Being aware of the types of common complications and associated risk factors helps the clinical team involved in the care of stroke patients to make preparations and plans for the best possible care and to take preventive measures that will save a lot of lives with best possible use of meager resources available such as educating the population to avoid oral feeding for patients with altered mental state and physicians to evaluate gag reflex bedside swallowing test and proper positioning of patients to avoid aspiration pneumonia. GSC measurement at admission is an important predictor of complications and death following stroke.