curaçao stroke questionnaire izzy gerstenbluth norédiz lourents november 12, 2010
TRANSCRIPT
CuraçaoStroke Questionnaire
Izzy Gerstenbluth
Norédiz Lourents
November 12, 2010
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Curaçao: Area & density
Area: 444 km²
Population Density per km²: 319
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Curaçao: population Population: circa 145.000
0-19 39.000 20-59 81.000 60+ 25.000 (17.4%)
Live births: ± 2000/ yr Deaths: ± 1000 -1200/yr
Life expectancy at Birth: ♀ 80.1 ♂ 72.4
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Intramural care facilities
Hospitals: St. Elisabeth (± 350 beds) Adventist Hospital (± 75 beds) Taams Kliniek (± 75 beds) Capriles Kliniek – psychiatric hospital
nursing home: Bethesda (± 160 beds) Geriatric homes (± 750 beds) Rehabilitation Clinic (Verriet Institute)
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Objectives
Measure BOD for common RF Planning (Stroke Unit) Quality of care (Interventions/protocols/
collaboration between health care providers)
Needs assessment Trends over time Research issues
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Set-up
STEP-1 STEP-2 ? Hospital/clinician based (Specialists &
Residents) Coordination & data management: ERU Admittance/imprint/pickup 2-3/wk Questionnaire in list Filled out upon discharge/ p-u 2-3/wk Check & review :missing data? Feed back meetings (1/month)
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
CSQ: May 1st- Nov 11th, 2010
133 strokes reported (73 males and 60 females) 123 were discharged and have filled out
Questionnaires; including 21 deceased Questionnaires of 10 patients (5 males and 5
females) are still pending in different wards of the Sint Elisabeth Hospital
Of the admitted patients 79% were admitted the same day or the day after the stroke; 8% were admitted 2 days after the stroke and 6.4% were admitted more than 3 days after the stroke. 3.4% had a stroke while in hospital.
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Number of strokes reported 1 May –11 Nov. 2010(n=123)
0
5
10
15
20
25
May June July Aug Sept Oct Nov
female
male
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Age distribution and gender for strokes recorded in May-Nov. 2010* (n=123)
0
5
10
15
20
25
>50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 90+
female
male
* May 1, 2010 – Nov 11, 2010; 21 persons died of which 6 were female and 15 were male
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Deceased patients by sex and age
0
1
2
3
4
5
>50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 90+
male female
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Type and subtypes of stroke Ischemic stroke: 92*
Cardio-embolism (21) large artery atherosclerosis (19) Small vessel occlusion (53) Other subtype (0)
Intracerebral hemorrhage 23 Subarachnoid hemorrhage 8 Unspecified type 1 Three (3) patients had also mention of subdural
hematoma *1 person had both cardio-embolism and a
small vessel occlusion
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Vital status and type of stroke (n=123)
Type of stroke Alive Deceased*
Ischemic stroke 79 13
Intracerebral hemorrhage 19 4
Subarachnoid hemorrhage 5 3
•One (1) patient died without mention of type of stroke but with mention of subdural hematoma
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Previous stroke
0
5
10
15
20
25
30
35
40
yes, records notseen
yes, records seen no, records seen no, records notseen
insufficient data
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Destination at discharge
0
10
20
30
40
50
60
70
80
deceased home elderly home nursing home rehab clinic other hospital unknown
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Riskfactors
0
20
40
60
80
100
120
yes no unknown
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Medication in hospital and at discharge
In hospital medication
Anticoagulant drugs 36
Antiplatelet drugs 70
Thrombolysis 1
Other medication 48
Medication at discharge
Anticoagulant drugs 26
Antiplatelet drugs 52
Antidiabetic drugs 28
Cholesterol lowering drugs 60
Antihypertensives 79
Other medication 17
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Modified Rankin scale pre stroke and at discharge
Modified Rankin scale Pre
stroke
At
Discharge* No symptoms at all 69 14
No significant disability 18 21
Slight disability 13 8
Moderate disability, able to walk 12 15
Moderate disability unable to walk 7 22
Severe disability 2 21
unknown 2 1
*21 patients died
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Modified Rankin scores pre-stroke vs. Modified Rankin scores at discharge
0
10
20
30
40
50
60
70
no symptoms
not significant disable
slight disable
moderate disable, able to walk
moderate disable unable to walk
severe disable
unknown
dead
at dischargepre stroke
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Percentage of deaths due to stroke
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
male
female
total
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Stroke Mortality
Year Position ♂ Position ♀ Total
1988 1 2 1
1989 2 2 2
1990 2 1 1
1991 2 1 1
1992 2 1 1
1993 1 1 1
1994 2 2 2
1995 2 2 2
1996 1 2 2
1997 3 2 2
1998 2 2 2
1999 3 2 3
2000 1 2 2
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
CSQ-data entry format in MS-Access
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Questionnaire
Obesity? WC SES data: problematic 1st stroke in “study period” & subsequent stroke Neuro signs present: broadened: problematic? Subtypes…subdural hematoma…?? TOAST MRA? Timing scanning left out? Vascular RF : cardioembolism/ alcohol?? Discharge questions: sI 16 deleted
CSQ 12 Nov, 2010; Gerstenbluth/Lourents
Not (yet ) included:
28 day follow-up (PH nurse?) Fatal stroke events in community (Step
2) Non fatal stroke events in community
(Step 3: Reporting from: Geriatric/nursing homes GP’s District nursing ?)