Abidin, Zainal Effendy Zainal
(2006)
Review of clinical predictors of haemorrhagic and ischaemic stroke in Emergency Department, HKL : an observational study.
Masters thesis, Universiti Sains Malaysia.
Abstract
The emergence of reperfusion therapy in acute ischemic stroke has revolutionized
the management of an acute ischemic stroke. However, this approach have been
hampered by lack of urgency from the patients itself, public and medical personnels.
These were probably due to lack of knowledge in current management from all involved.
Aim of this study is to review common signs and symptoms in stroke and to see if
we can safely differentiate between types of stroke. This study also wants to look at time
taken by each patient to arrive at Emergency Department.
METHOD:
A cross-sectional observational study for all clinically diagnosed stroke patients
admitted to Hospital Kuala Lumpur from January to May 2005 after fulfilling the
inclusion and exclusion criteria. All patients were subjected to brain Computed
Tomography.
Common signs and symptoms on admission that were reviewed are: Age, sex,
ethnic, Glasgow Coma Scale, Systolic and Diastolic blood pressure, loss of
consciousness, headache and vomiting.
RESULTS:
A total of one hundred and forty-three (Eighty-eight male and fifty-five female)
patients were included in this study. Sixty-four point three percent of patients presented
to Emergency Department six hours after the initial symptoms started with majority of
them are ischemic stroke patients. Haemorrhagic stroke patients are more likely to be
younger (mean age of fifty-one years versus fifty-six years), to have symptoms of loss of
consciousness (twenty-three point one percent: p value less than 0.001), headache
(Eighteen point two percent: p value less than 0.001) and vomiting (nine point eight: pvalue less than 0.001), and lower Glasgow Coma Scale (mean=9, Standard
Deviation=2.8) and higher Systolic blood pressure (mean=174.77, Standard
Deviation=22.5).
CONCLUSION:
Significant predictors for stroke patients to have higher probability of
haemorrhagic type are lower age group, presented with loss of consciousness, headache
and vomiting, and have lower Glasgow Coma Scale and higher Systolic blood pressure.
Ischemic stroke patients are more likely to present late, more than six hours to
Emergency Department while Haemorrbagic stroke patients are more likely to present
earlier, within three to six hours.
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