Decreased in mortality and morbidity of ischemic stroke patients after cared by multidisciplinary team in Prapokklao Hospital.

Abstract

Background : The stroke corner and multidisciplinary care have been establised for acute ischemic stroke care. However little is known about the process and outcome of stroke care in Prapokklao Hospital.

Objective : To compare the mortality, neurological and medical morbidity, length of stay and readmission in 28 days of acute ischemic stroke patients in 2003 with those admitted in 2005.

Material and method : The author retrospectively collected data of all acute ischemic stroke patients who were admitted in the medical ward of Prapokklao Hospital in 2003 and compared with prospectively data of those who admitted for the same conditions in 2005. All stroke patients were cared by conventional treatments in 2003. All those patients in 2005 were cared by multidisciplinary team or care map team approach under the clinical guidelines and followed by homecare treatment.The endpoints were hospital mortality, neurological and medical morbidity, the mean length of stay and recurrent readmission in 28 days.

Result : There were 726 patients admitted with acute ischemic stroke include in the studied. Three hundred and twenty patients were admitted in 2003 and 406 patients were admitted in 2005. Among the two groups of patients, there were no significance differences in risk factors and severity of strokes or subtypes,except for dyslipidemia and cigarette smoking habit which were more prevalent in patients admitted in 2005. Stroke patients in 2005 cared for by a care map team had a significance decreased in mortality compared with those in 2003 (8.7 percent and 3.4 percent p<0.01). Overall morbidity in 2003 was 40.3 percent compared to 33.3 percent (p=0.04) of those in 2005. There was significantly less pneumonia, urinary tract infections, pressure sores and upper gastrointestinalbleeding were also observed. The mean length of stay of stroke patients admitted in 2003 and 2005 were 8.13 and 6.14 days (p<0.01) respectively. Readmission in 28 days of stroke patients admitted in 2003 was 5 percent compared to 1.5 percent (p<0.01) of those admitted in 2005.

Conclusion : A multidisciplinary team has decreased the mortality, morbidity, length of stay and readmission in 28 days of ischemic stroke patients in Prapokklao Hospital.

Key wards : stroke corner, multidisciplinary team, ischemic stroke, mortality, morbidity.