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Open Access Research article

A prospective cohort study of stroke characteristics, care, and mortality in a hospital stroke registry in Vietnam

David L Tirschwell1, Thanh G N Ton1*, Kiet A Ly2, Quang Van Ngo3, Tung T Vo3, Chien Hung Pham3, William T Longstreth14 and Annette L Fitzpatrick45

Author Affiliations

1 Department of Neurology, Harborview Medical Center, Room 3EH70, 325 Ninth Avenue, Seattle, WA, 98104, USA

2 Department of Dental Public Health Sciences, University of Washington, 1959 NE Pacific Street, Box 356365, Seattle, WA, 98195, USA

3 Department of Health, 103 Hung Vuong Street, Da Nang, Vietnam

4 Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Box 359236, Seattle, WA, 98195, USA

5 Department of Global Health, Harborview Medical Center, 325 9th Ninth, Seattle, WA, 98104, USA

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BMC Neurology 2012, 12:150  doi:10.1186/1471-2377-12-150

Published: 3 December 2012

Abstract

Background

As low and middle-income countries such as Vietnam experience the health transition from infectious to chronic diseases, the morbidity and mortality from stroke will rise. In line with the recommendation of the Institute of Medicine’s report on “Promoting Cardiovascular Health in the Developing World” to “improve local data”, we sought to investigate patient characteristics and clinical predictors of mortality among stroke inpatients at Da Nang Hospital in Vietnam.

Methods

A stroke registry was developed and implemented at Da Nang Hospital utilizing the World Health Organization’s Stroke STEPS instrument for data collection.

Results

754 patients were hospitalized for stroke from March 2010 through February 2011 and admitted to either the intensive care unit or cardiology ward. Mean age was 65 years, and 39% were female. Nearly 50% of strokes were hemorrhagic. At 28-day follow-up, 51.0% of patients with hemorrhagic stroke died whereas 20.3% of patients with ischemic stroke died. A number of factors were independently associated with 28-day mortality; the two strongest independent predictors were depressed level of consciousness on presentation and hemorrhagic stroke type. While virtually all patients completed a CT during the admission, evidence-based processes of care such as anti-thrombotic therapy and carotid ultrasound for ischemic stroke patients were underutilized.

Conclusions

This cohort study highlights the high mortality due in part to the large proportion of hemorrhagic strokes in Vietnam. Lack of hypertension awareness and standards of care exacerbated clinical outcomes. Numerous opportunities for simple, inexpensive interventions to improve outcomes or reduce recurrent stroke have been identified.

Keywords:
Hemorrhage; Ischemia; Mortality; Risk factors; Stroke