Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon
Background: Despite the increasing availability of head computerized tomography (CT) in resource-limited settings, it is unclear if brain-imaging-based diagnosis of stroke affects the outcomes in the absence of dedicated structures for acute stroke management. Objectives: In a major referral hospita...
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doaj-122610fd09784b4b9b69211c7c9b998c2020-11-24T20:49:53ZengElseviereNeurologicalSci2405-65022016-03-012C3710.1016/j.ensci.2016.01.003Computed tomography scanning and stroke mortality in an urban medical unit in CameroonAlain Lekoubou0Clovis Nkoke1Anastase Dudzie2Andre Pascal Kengne3Department of Neurology, Medical University of SC, Charleston, USAFaculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, CameroonDouala General Hospital and Buea Faculty of Medicine, Department of Internal Medicine, Douala, CameroonDepartment of Medicine, University of Cape Town, Cape Town, South AfricaBackground: Despite the increasing availability of head computerized tomography (CT) in resource-limited settings, it is unclear if brain-imaging-based diagnosis of stroke affects the outcomes in the absence of dedicated structures for acute stroke management. Objectives: In a major referral hospital in the capital city of Cameroon, we compared in-hospital mortality rates in patients with a WHO-based diagnosis of stroke between participants with and without brain imaging on admission. Methods: Stroke patients with and without admission brain imaging were compared for demographic characteristics, risk factors, clinical and laboratory characteristic, and in-hospital mortality. Heterogeneities in mortality rates (CT vs. No CT) across major subgroups were investigated via interaction tests, and logistic regressions used to adjust for extraneous factors such as age, sex, year of study, residency, history of diabetes and hypertension, history of stroke, Glasgow coma scale, and delay between stroke symptoms onset and hospital admission. Results: Of the 1688 participants included in the final analysis, 1048 (62.1%) had brain imaging. The median age of the non-CT vs. CT groups was 65 vs. 62 years (p-value < 0.0001%). The death rate of non-CT vs. CT groups was 27.5% vs. 16.4% (p < 0.0001). This difference was mostly similar across major subgroups, and robust to the adjustments for confounders (in spite of substantial attenuation), with excess deaths in those with CT ranging from 65% to 149%. Conclusion: In this resource-limited environment, the absence of brain imaging on admission was associated with high in-hospital death from stroke, which was only partially explained by delayed hospitalization with severe disease. These results stressed the importance of scaling up acute stroke management in low- and middle-income countries.http://www.sciencedirect.com/science/article/pii/S240565021600006XSub-Saharan AfricaCameroonStrokeComputerized tomographyMortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alain Lekoubou Clovis Nkoke Anastase Dudzie Andre Pascal Kengne |
spellingShingle |
Alain Lekoubou Clovis Nkoke Anastase Dudzie Andre Pascal Kengne Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon eNeurologicalSci Sub-Saharan Africa Cameroon Stroke Computerized tomography Mortality |
author_facet |
Alain Lekoubou Clovis Nkoke Anastase Dudzie Andre Pascal Kengne |
author_sort |
Alain Lekoubou |
title |
Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon |
title_short |
Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon |
title_full |
Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon |
title_fullStr |
Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon |
title_full_unstemmed |
Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon |
title_sort |
computed tomography scanning and stroke mortality in an urban medical unit in cameroon |
publisher |
Elsevier |
series |
eNeurologicalSci |
issn |
2405-6502 |
publishDate |
2016-03-01 |
description |
Background: Despite the increasing availability of head computerized tomography (CT) in resource-limited settings, it is unclear if brain-imaging-based diagnosis of stroke affects the outcomes in the absence of dedicated structures for acute stroke management.
Objectives: In a major referral hospital in the capital city of Cameroon, we compared in-hospital mortality rates in patients with a WHO-based diagnosis of stroke between participants with and without brain imaging on admission.
Methods: Stroke patients with and without admission brain imaging were compared for demographic characteristics, risk factors, clinical and laboratory characteristic, and in-hospital mortality. Heterogeneities in mortality rates (CT vs. No CT) across major subgroups were investigated via interaction tests, and logistic regressions used to adjust for extraneous factors such as age, sex, year of study, residency, history of diabetes and hypertension, history of stroke, Glasgow coma scale, and delay between stroke symptoms onset and hospital admission.
Results: Of the 1688 participants included in the final analysis, 1048 (62.1%) had brain imaging. The median age of the non-CT vs. CT groups was 65 vs. 62 years (p-value < 0.0001%). The death rate of non-CT vs. CT groups was 27.5% vs. 16.4% (p < 0.0001). This difference was mostly similar across major subgroups, and robust to the adjustments for confounders (in spite of substantial attenuation), with excess deaths in those with CT ranging from 65% to 149%.
Conclusion: In this resource-limited environment, the absence of brain imaging on admission was associated with high in-hospital death from stroke, which was only partially explained by delayed hospitalization with severe disease. These results stressed the importance of scaling up acute stroke management in low- and middle-income countries. |
topic |
Sub-Saharan Africa Cameroon Stroke Computerized tomography Mortality |
url |
http://www.sciencedirect.com/science/article/pii/S240565021600006X |
work_keys_str_mv |
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