Healthcare circuits and functional outcomes 3 and 12 months after a stroke in a population-based cohort of 929 patients.
Dr Laure HUCHONa, Dr Anne TERMOZb, Dr Julie HAESEBAERTb, Prof Gilles RODEa, Prof Anne-Marie SCHOTTb
a Hôpital Henry Gabrielle, Hospices Civils de Lyon, b Pôle Information Médicale Evaluation et Recherche Clinique, Hospices civils de Lyon
Objectives and Methods. There are few epidemiologic data about stroke collected on a large, non-selected and representative population of stroke patients. We present a population-based cohort study which included all adult ischemic (IS) or hemorrhagic (HS) stroke cases recorded in the Rhône area (1.7 million inhabitants) for seven months. The aim was to provide an accurate description of: the demographic characteristics of stroke patients, their healthcare circuits (pre-hospital, acute and secondary phases), their activity limitations 3 and 12 months after stroke through the modified Rankin Scale (mRS) and the Barthel Index (BI), and to identify factors associated with the mRS 1 year after stroke by an univariate and then multivariate analysis.
Results. 929 stroke cases have been recorded (697 IS, 232 HS, mean age 74.1 years, sex ratio=1). Only 44.5% of patients were oriented prior to hospital admission by the emergency medical dispatch service. 85.4% of patients were first admitted to an emergency department, whereas 8.8% of patients were admitted directly to stroke unit. Only 17% of stroke patients were referred to stroke unit during their healthcare circuit, and more than 55% have never been admitted in a neurology department. Mortality rate was 12.1% one month after stroke and 31% three months after stroke in the ischemic group, compared with 34% and 52% respectively in the hemorrhagic group. Mortality did not increase between the third and the twelfth month post-stroke. A favorable functional outcome (mRS≥2) one year after stroke has been obtained for 47% of IS and 34.6% of HS. The mean BI at one year was 68.5 among surviving patients. Age>80 years, female sex and presence of severity criteria in acute phase were significant factors associated with non-favorable outcome.
Discussion. In this study, carried out with an exhaustive population within a region and a one-year follow-up with few missing data, the results show a morbi-mortality after stroke higher than the one reported in previous studies. The results also confirm the better prognosis of IS.
Keywords : Stroke, Healthcare circuits, Epidemiology, Prognosis, Functional outcome, Activity limitations, Disability, Mortality