Neuro-epidemiology of Acute Stroke Syndrome in the Adult Emergency Department of a Tertiary Hospital in a Resource-limited Environment of South-eastern Nigeria

Abstract

Background: Globally, acute stroke is one of the leading causes of preventable emergency hospital admissions. It is emerging as an important cause of disability and mortality among adult Nigerian Africans in the emergency department(ED) of Nigerian hospitals. Aim: The study was designed at reviewing epidemiology of acute stroke syndrome in the adult ED of a tertiary hospital in South-east Nigeria. Study Design: This was a retrospective descriptive study. Place and Duration of Study: The study was carried out on patients with acute stroke syndrome at the ED of Federal Medical Centre, Umuahia, Nigeria over a five year period from January 2008 to December 2012. Methods: The sources of data were from medical records, patients’ case notes; ED admission registers and nurses report books. Information collected were age, sex, place of the incidence, time of presentation to the ED, duration of symptoms at presentation, month (season) of occurrence, type of stroke, number of episodes and associated clinical conditions. Operationally, time of presentation to the ED was categorized into two: day time was defined inclusively as time period from 6.00 am to 6.00 pm while night time referred exclusively to the time period from 6.00 pm to 6.00 am Nigerian time. Early presentation to the ED meant that the victim arrived the ED of the hospital inclusively within 1 hour of the occurrence of the acute stroke while those that arrived after 1 hour were defined as late presentation to the hospital. Results: The age ranged from 36 years to 95 years with mean age of 68.2±7.4 years. There were 155 (58.3%) males and 111 (41.7%) females with male to female ratio of 1.4: 1. The incident predominantly occurred at home (77.8%), 239 (89.8%) had duration of symptoms more than 1 hour at presentation, 162 (60.9%) presented during the night time, 158 (59.4%) occurred during dry season, 157 (59.1%) had repeat episode, 199 (74.8%) were ischemic stroke and the most commonly associated clinic-medical condition was hypertension (80.1%). Conclusion: There was variability in the epidemiology of stroke with ischemic stroke being the pre-eminent type and hypertension the most associated clinical condition. The incident occurred predominantly among male gender, elderly patients, at home, during dry season and most of the patients presented late to the ED and at night time. Interventional strategies aimed at risk reduction, early presentation to dedicated and responsible stroke units and centres are advocated.