Norzilah, Abu Zaharin
(2008)
A retrospective study of in hospital time management of acute stroke patient in the
emergency department Hospital Kuala Lumpur.
Masters thesis, Universiti Sains Malaysia.
Abstract
The Emergency Department Hospital Kuala Lumpur commonly receives cases of
patients presented with signs and symptoms of acute stroke in which majority of them are
send for CT Brain for confirmation of diagnosis. However in a case of acute ischaemic
stroke none of them had been given fibrinolytic therapy or r-tpa in which assumption
made that the patient had missed the beneficial period of the therapy which is within 3
hours from the onset of symptoms. The objectives of the study are to analyse the in-hospital time taken for stroke patients
when arrives in the Emergency Department until the diagnosis of stroke is confirmed.
This will include the time interval from door to medical consultation,door to CT scan
performed till door to CT scan film interpreted.Besides this the time of symptoms onset is
also studied as well as the demographic profile of the stroke patients. The association
between the demographic factor and stroke risk factors with the time of hospital arrival
is also include in the study. A total of 200 patients were involved in the study. All subjects were those age more
than 18 years old who presented to the emergency department with the signs and
symptoms of acute stroke and had CT brain done.The data analyse will be collected
retrospectively through case notes in which the detail of the patients, demographic
factor, history of presenting complaint, past medical history, social history, time
documentation when seen by doctor till CT film interpretation will be reviewed. In this
study the data analysed are stroke patients presented to the Emergency Department
Hospital Kuala Lumpur in a period of 1 year from 1st April 2007 until 31st March 2008 From 200 patients 42% of them are Malay followed by Chinese (36.5%), Indian (18.5%)
and others (3.0%). Male accounted for 65% while female accounted for 35%. The mean
age was 58.3 years old with 58.5% were more than 55 years old. The CT brain finding
shows infarct in 42.5% of patients, normal CT finding accounted for 39% and
haemorrhagic stroke in 18.5% of patients. The percentage of patients who arrived more
than 3 hours from the onset of symptoms was 73% while less than 3 hours was 27% .
Most of the patient is triaged to the yellow zone which accounted for 45.5%, followed by
the green zone which is 41.5% and the red zone (13%) . As for the in-hospital time
analysis, it is found that the mean time interval for door to medical consultation is 24.2
minutes and the mean time interval for door to CT is 52.3 minutes. Hypertension occurs
highest most among the patients (52.5%) followed by diabetes (41.5%),family history of stroke (23%), smoking (21%), ischaemic heart disease (14.5%), previous history of
stroke (8%) and hyperlipidaemia (3.5%).
There is a significant association between time of hospital arrival and age in which pvalue
is less than 0.05. The significant independent predictors for time of hospital arrival
is age (OR 1.83,95% CI 0.958,3.502), Hypertension (OR 1.99,95% CI 0.989,3.906) and
ischaemic heart disease (OR 0.424,95%CI 0.174,1.036). 73% of stroke patients arrives late to the Emergency Department Hospital Kuala
Lumpur. There is also an in-hospital delay in which may jeopardise the chance of patient
for fibrinolytic therapy. Critical pathway might need to be structured in the emergency
department to overcome the delay, hence improving the care of stroke patient.
Actions (login required)
 |
View Item |
