Retrospective evaluation of mortality among stroke patients receiving thrombolytic therapy in the emergency department

Abstract

Aims: Since strokes are an important cause of morbidity and mortality all over the world, early diagnosis and treatment are extremely important for sequela-free recovery. The best treatment option for an ischemic stroke is intravenous thrombolytic therapy with recombinant tissue plasminogen activator. In this study, we aimed to determine the factors affecting in-hospital mortality among patients who presented to the emergency department due to an ischemic stroke and received thrombolytic therapy. Methods: This cross-sectional study reviewed the medical records of patients who presented to the emergency department with stroke symptoms between January 2018 and August 2022, were diagnosed with ischemic stroke, received thrombolytic treatment within the first 4.5 hours of symptom onset, and were subsequently hospitalized. Results: After excluding patients who did not meet the inclusion criteria, 184 patients were included in the study. It was found that 42 (22.8%) of the patients had an exitus in the follow-up. We determined that the mortality rate was higher in patients admitted to the emergency department with emergency health services compared to outpatients (p<0.05). Mortality frequency was higher in patients who had a National Institutes of Health Stroke Scale (NIHSS) score ≥21 or were hospitalized for more than 14 days (p<0.05). In univariate analysis, age, admission route, length of hospital stay, and NIHSS score were associated with mortality. Multiple logistic regression analysis demonstrated that patients with an NIHSS score ≥21 had an 18.49-fold higher risk of death (95% CI: 6.55–52.20) compared to those with a score ≤20. Conclusion: In our study, it was observed that the mortality rate was increased in patients who were aged 65 and over, had diabetes mellitus or atrial fibrillation comorbidities, were admitted to the hospital with emergency health services, were hospitalized for more than 14 days, and had NIHSS score of 21 and above.

Keywords

• Ischemic stroke
• thrombolytic therapy
• mortality

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