Hospital-based stroke care in Ireland: results from one regional register

Background Most patients with acute stroke are admitted to hospital. If str oke services in this country are to be improved, we need accurate and relia ble information about the types of stroke patients being admitted, their pr esent management and outcome. Aims To examine the demography, severity, level of investigation, length of stay, mortality and discharge location of prospectively identified consecu tive stroke admissions to three general hospitals in South East Dublin. Results Three hundred and twenty nine consecutive stroke admissions to thre e general hospitals in South East Dublin were registered using the European Stroke Database over 50 weeks. The mean age was 73.3 years, whilst 20.1% p atients were under 65 years. Prior to admission, 90% of patients were commu nity dwelling with 14.9% of patients being dependent in activities of daily living. 22.4% of patients had some depression in level of consciousness on admission. The overall mortality rate was 26.1% whilst 136 (41.3%) were di scharged home, 50 (15.2%) went to institutional care and 45 (13.7%) went to non general hospitals secondary rehabilitation units. The mean length of s tay was 31.3 days. The combined poor outcome measure (mortality plus percen tage of patients discharged to institutional care), was lower in one hospit al compared to the other two hospitals (29.3% versus 44.65%, p greater than or equal to 0.05) probably reflecting case mix. Stroke accounted for 4.2% of all bed days in the major general hospital in this area. The overall CT scan rate was 84.5%, with 18.2% of CT scans showing a haemorrhagic componen t and two patients (0.8%) having brain tumours. Carotid doppler examination s were carried out in 37% of patients. Conclusion The results demonstrate the high mortality and prolonged hospita l stay for stroke patients in this area and emphasise the need for co-ordin ated stroke care and regular audit to ensure most effective use of hospital resources.