The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report
The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report
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DOI：
10.4314/mmj.v31i4.6
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发表时间：
2019-12-01
影响因子：
0.8
通讯作者：
Mwandumba, Henry C.
中科院分区：
文献类型：
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作者：
Gadama, Yohane;Kamtchum-Tatuene, Joseph;Mwandumba, Henry C.
背景伊丽莎白女王中心医院 (QECH) 正准备在马拉维布兰太尔建立第一个中风病房。我们进行这次审计是为了评估 QECH 当前的卒中管理实践和结果，并确定干预的优先领域。方法从 2018 年 4 月到 6 月，我们前瞻性地入组急性卒中患者，收集有关临床表现、心血管危险因素、调查和干预、院内结果以及出院后随访计划的数据。美国心脏协会/美国中风协会 (AHA/ASA) 指南被用作比较的护理标准。结果 纳入了 50 名急性中风患者（46% 女性，54% 男性）。平均年龄为 63.1 岁（95% CI：59.7-66.6）。中风的诊断是基于世界卫生组织的标准。 19 名患者（38%）在入院 24 小时内做出诊断。无法进行急性血运重建治疗。 48 名患者 (96%) 在基线时检查了生命体征，34 名患者 (68%) 的生命体征为 140/90 mmHg，其中 4 名患者的值 >220/120 mm/Hg。 9 名患者的 RBS >10 mmol/L，4 名患者接受了胰岛素治疗。 12 名患者 (24%) 接受了深静脉血栓形成的预防治疗。 16 名患者 (32%) 报告吸入性肺炎，是最常见的医院并发症。平均住院时间为 10.4 天（95% CI：5.6-15.2），病死率为 18%。出院时修正的兰金量表为
BackgroundThe Queen Elizabeth Central Hospital (QECH) is preparing to set up the first stroke unit in Blantyre, Malawi. We conducted this audit to assess current stroke management practices and outcomes at QECH and identify priority areas for intervention.MethodsFrom April to June 2018, we prospectively enrolled patients with acute stroke and collected data on clinical presentation, cardiovascular risk factors, investigations and interventions, in-hospital outcomes, and follow-up plans after discharge. The American Heart Association/American Stroke Association (AHA/ASA) guidelines were used as the standard of care for comparison.ResultsFifty patients with acute stroke were enrolled (46% women, 54% men). The mean age was 63.1 years (95% CI: 59.7-66.6). The diagnosis of stroke was based on the World Health Organization criteria. The diagnosis was made within 24 hours of admission in 19 patients (38%). Acute revascularisation therapy was not available. Forty-eight patients (96%) had their vital signs checked at baseline and 140/90 mmHg in 34 patients (68%), including 4 with values >220/120 mm/Hg. Nine patients had an RBS >10 mmol/L and four received insulin. Prophylaxis for deep venous thrombosis was offered to 12 patients (24%). Aspiration pneumonia was reported in 16 patients (32%) and was the most common hospital complication. The mean duration of hospitalisation was 10.4 days (95% CI: 5.6-15.2), and case fatality was 18%. The modified Rankin scale at discharge was