scholarly journals Correlation of Glasgow Coma Scale Score at Hospital Admission with Stroke Hemorrhagic Patient Mortality at Hasan Sadikin Hospital

2019 ◽  
Vol 2 (4) ◽  
Author(s):  
Ary Setio Hartanto ◽  
Andi Basuki ◽  
Cep Juli
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Admission ◽  
Hemorrhagic Stroke ◽  
P Value ◽  
Stroke Patients ◽  
Coma Scale ◽  
Risk Of Death ◽  
Increased Risk ◽  
Level Of Consciousness ◽  
Gcs Score

Stroke is the most common cause of death in Indonesia. Stroke is divided into ischemic and hemorrhagic stroke. Hemorrhagic stroke has a higher risk of death than ischemic stroke. Hemorrhagic stroke can disrupt patient’s consciousness. The Glasgow Coma Scale (GCS) is a scale that is widely used to assess level of consciousness. Accurate predictors can help doctors determine prognosis and treatment for stroke patient. This study was conducted to determine the correlation of GCS scores at the time of hospital admission and mortality of hemorrhagic stroke patients at Hasan Sadikin Hospital. This study is a retrospective cohort analytic study involving 134 subjects. Data were analyzed using Kolmogorov-Smirnov’s and Fisher's analysis test with significance of p <0.05. From the results of the study, the p value was 0.00, subjects with GCS score somnolence (12-14) had six times higher risk in mortality (P = 0.02, RR = 6.38) and subjects with GCS score sopor and coma (3 - 11) had twenty four times higher risk in mortality (P = 0.00, RR = 23.85). We concluded that decreased score of SKG at the time of hospital admission was associated with increased risk of death in hemorrhagic stroke patients at Hasan Sadikin Hospital.   Keywords: Glasgow Coma Scale, hemorrhagic stroke, mortality

Mortality and Functionality after Stroke in Patients with Systemic Lupus Erythematosus

2017 ◽  
Vol 44 (11) ◽  
pp. 1590-1596 ◽  
Author(s):  
Marios Rossides ◽  
Julia F. Simard ◽  
Elisabet Svenungsson ◽  
Mia von Euler ◽  
Elizabeth V. Arkema
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Ischemic Stroke ◽  
Risk Ratio ◽  
Functional Impairment ◽  
Lupus Erythematosus ◽  
Hemorrhagic Stroke ◽  
Stroke Patients ◽  
Systemic Lupus ◽  
Risk Of Death ◽  
Increased Risk

Objective.To investigate mortality and functional impairment after stroke in systemic lupus erythematosus (SLE).Methods.Using Swedish nationwide registers, we identified 423 individuals with SLE and 1652 people without SLE who developed a first-ever ischemic or hemorrhagic stroke (1998–2013) and followed them until all-cause death or for 1 year. HR for death after ischemic or hemorrhagic stroke and the risk ratio of functional impairment (dependence in either transferring, toileting, or dressing) 3 months after ischemic stroke were estimated.Results.One year after stroke, 22% of patients with SLE versus 16% of those without SLE died. After ischemic stroke, patients with SLE had an increased risk of death (HR 1.85, 95% CI 1.39–2.45), which was attenuated after controlling for SLE-related comorbidities (HR 1.41, 95% CI 1.04–1.91). Functional impairment at 3 months was increased in SLE by almost 2-fold (risk ratio 1.73, 95% CI 1.16–2.57). After hemorrhagic stroke, patients with SLE had an HR of 2.30 (95% CI 1.38–3.82) for death, which was increased even during the first month.Conclusion.Compared to subjects without SLE, mortality after ischemic stroke increases after the first month in individuals with SLE, and functionality is worse at 3 months. SLE is associated with all-cause death after hemorrhagic stroke even during the first month. A shift of focus to patient functionality and prevention of hemorrhagic strokes is required.

scholarly journals Risk factors for swallowing dysfunction in stroke patients

2012 ◽  
Vol 49 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Anna Flávia Ferraz Barros Baroni ◽  
Soraia Ramos Cabette Fábio ◽  
Roberto Oliveira Dantas
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Stroke Patients ◽  
Radiologic Diagnosis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Swallowing Dysfunction ◽  
Level Of Consciousness ◽  
Swallowing Evaluation ◽  
Oral Expression

CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

scholarly journals Pengaruh Familiar Auditory Sensory Training Pada Tingkat Kesadaran Pasien Stroke Di RSD dr. Soebandi Jember

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Cirilia Aripratiwi ◽  
Jon Hafan Sutawardana ◽  
Mulia Hakam
Keyword(s):  
Glasgow Coma Scale ◽  
Pharmacological Therapy ◽  
Wilcoxon Test ◽  
Neurological Deficits ◽  
Control Group ◽  
P Value ◽  
Stroke Patients ◽  
Coma Scale ◽  
Patient Awareness ◽  
Sensory Training

ABSTRAKStroke dapat menyebabkan penurunan kesadaran. Pada kasus stroke dengan penurunan kesadaran dapat mengakibatkan pasien mengalami kematian, defisit neurologi, semakin lamanya waktu perawatan, dan akan meningkatkan biyaya perawatan. Kasus stroke dengan penurunan kesadaran banyak dijumpai di RSD dr. Soebandi Jember. Namun upaya perawat dalam meningkatkan kesadaran pasien berfokus pada terapi farmakologi sehingga memerlukan terapi non farmakologi seperti terapi Familiar Auditory Sensory Training (FAST) untuk membantu proses pemulihan kesadaran. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh FAST pada tingkat kesadaran pasien stroke. Penelitian didesain dengan quasi experimental menggunakan rancangan Non equivalent control group melibatkan 29 pasien stroke yang mengalami penurunan kesadaran. 29 pasien dibagi menjadi 15 kelompok intervensi yang diberi terapi FAST selama tiga hari. FAST diberikan 3 kali sehari. 14 pasien berikutnya dalam kelompok kontrol hanya dilakukan pemeriksaan GCS. Tingkat kesadaran pasien diukur menggunakan instrumen Glasgow Coma Scale (GCS) yang terdiri dari 3 komponen yakni respon mata, verbal, dan motorik. Data dianalisis dalam SPSS menggunakan uji Mann-Whitney dan uji Wilcoxon. Hasil analisis uji baik pada kelompok intervensi maupun kontrol diperoleh nilai p 0,010 (nilai p α). Hasil uji yang signifikan membuktikan bahwa ada pengaruh FAST dalam meningkatkan kesadaran pasien stroke. FAST dapat dijadikan terapi nonfarmakologi untuk membantu proses pemulihan kesadaran pada pasien stroke.ABSTRACTStroke can cause a decrease in consciousness. In the case of stroke with decreased consciousness can result in the patient experiencing death, neurological deficits, the longer treatment time, and will increase the cost of treatment. Cases of stroke with decreased consciousness are often found in RSD dr. Soebandi Jember. However, nurses' efforts in increasing patient awareness focus on pharmacological therapy so that it requires non-pharmacological therapy such as Familiar Auditory Sensory Training (FAST) therapy to help the process of recovering consciousness. The purpose of this study was to determine the effect of FAST on the level of awareness of stroke patients. This study involved 29 stroke patients who experienced a decrease in consciousness. 29 patients were divided into 15 intervention groups who were given FAST therapy for three days. FAST is given 3 times a day. The next 14 patients in the control group only performed GCS examination. The level of patient awareness was measured using the Glasgow Coma Scale (GCS) instrument consisting of 3 components namely eye, verbal, and motor response. Data were analyzed in SPSS using the Mann-Whitney test and Wilcoxon test. The results of the test analysis in the intervention and control groups obtained p-value 0.010 (p-value α). Significant test results prove that there is an influence of FAST in increasing stroke patient awareness. This study shows that nurses should be able to increase the application of nonpharmacological therapies such as FAST to help the process of recovering consciousness in stroke patients.

scholarly journals Assessment of Nurse’s Knowledge About Glasgow Coma Scale at al Dhafra Hospitals, Abu Dhabi, United Arab Emirates 2018

2018 ◽  
Vol 3 (7) ◽  
Keyword(s):  
Glasgow Coma Scale ◽  
United Arab Emirates ◽  
Neurological Examination ◽  
Abu Dhabi ◽  
Patient Specific ◽  
P Value ◽  
Cross Sectional ◽  
Coma Scale ◽  
Level Of Consciousness ◽  
The Difference

Background: The most important assessment in the neurological examination is to assess the level of consciousness (LOC), which is considered as the first step in neurological examination. Detecting the changes in level of consciousness depends on the accuracy of nursing assessment. The nurses should be knowledgeable, confident, and quick in performing this task. Purpose: of this study is to assess UAE nurses’ knowledge about GCS working in Al Dhafer Hospitals, Abu Dhabi, United Arab Emirates. Methodology: This study was carried out in the Dhafra hospitals, Abu Dhabi, United Arab Emirates in April 2018. It is a cross-sectional, descriptive study. Eighty-five nurses met the inclusion criteria, the survey was sent to 165 nurses (Respondent rate 51%). Data collection was carried out using a survey monkey instru¬ment called “Glasgow Coma Scale”. Data coding, entry and analysis has been conducted using SPSS 20 software. The difference has been tested at 95% level of significance, and the difference that has P-value < 0.05 was considered significant. Results: The study revealed that the knowledge percentages mean of correct answers about GCS is 56.1 % {SD: ±11.7; 95% CI: [26.67-100]}. On the other hand, it revealed also that the percentages of nurses who have a good knowledge about GCS were 50.6% and staffs whom have poor knowledge were 49.4 %. Moreover, the results revealed significant relation between gender and GCS training with level of GCS knowledge. Conclusion and recommendations: The present study showed that the nurses in Al-Dhafra hospitals reflect inadequate knowledge. This finding raises concerns about the importance of knowledge and skill in assessing GCS. Continuing education and practice on the use of the GCS tool are important. A Brochure and booklet should be designated and distributed to all nurses who working in critical care units and dealing with an unconscious patient. Specific and advanced courses about GCS should be conducted in Al-Dhafra hospitals.

scholarly journals Relation of Volume of Hemorrhage With Mortality Within First 48 Hours in Hemorrhagic Stroke

KYAMC Journal ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 127-132
Author(s):  
Sk Abdullah Al Mamun ◽  
Saiyeedur Rahman ◽  
Sayedur Rahman Sheikh ◽  
Abdul Wadud ◽  
Gobindo Gain
Keyword(s):  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Mortality Rates ◽  
Advanced Age ◽  
Coma Scale ◽  
Level Of Consciousness ◽  
Hemorrhage Volume ◽  
Scale 8

Background: Hemorrhagic stroke accounts for 10-15% of all strokes with higher mortality rates than cerebral infarction. Intracerebral hemorrhage has a reported 30-day mortality of 44% to 51%, with almost half of the death occurs within the first 48 hours. Advanced age, low level of consciousness, large volume of hemorrhage has been linked with poor outcome. Objectives: To predict early outcome of hemorrhagic stroke patient in relation with age, Glasgow Coma Scale, volume of hemorrhage and ventricular extension. Materials and Methods: Hospital based prospective study carried out in hundred hemorrhagic stroke patients. The formula of ABC/2 was used to calculate hemorrhage volume in bedside by using CT scan. Results: 1st month mortality rates of hemorrhagic stroke was 44% with 45.45% of patients died within the first 48 hours of onset. Mean age of patients of hemorrhagic stroke was 61.2 ± 13.88 years. Mortality rate of intracerebral hemorrhage after age of 60 was 51.06% in 1st month. Volume of intracerebral hemorrhage was the strongest predictor of both 48 hours and 30 days mortality. Using three categories of intracerebral hemorrhage (X for < 30 ml, Y for 30 - 50 ml and Z for > 50 ml group) calculated by ABC/2 formula showed 100% mortality rate in Z group, 50% in Y group and only 12% mortality rate in X group in 1st month. Among all death, 61.5% of Z group 25% of Y group and 16.67% of patients of X group died within 48 hours. Two categories of Glasgow Coma Scale (≤ 8 and ≥ 9) were used and shown death rates 80.77% in GCS ≤ 8 and 4.55% in GCS ≥ 9 in 1st month. Conclusion: Volume of intracerebral hemorrhage in combination with advanced age, initial Glasgow Coma Scale is a powerful and easy to use in both 48 hours and 1st month mortality in patients with spontaneous intracerebral hemorrhage. KYAMC Journal. 2021;12(3): 127-132

scholarly journals Hubungan antara Waktu Tindakan Intubasi dengan Outcome Pasien Stroke di RSUP Prof. Dr. R. D. Kandou Manado: Kajian terhadap Glasgow Coma Scale, Ventilator Associated Pneumonia, Length of Stay, dan Angka Kematian

e-CliniC ◽  
2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Timothy M. Poluan ◽  
Diana C. H. Lalenoh ◽  
Barry I. Kambey
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Glasgow Coma Scale ◽  
Ventilator Associated Pneumonia ◽  
Intubation Time ◽  
Stroke Patients ◽  
Keywords Stroke ◽  
Coma Scale ◽  
Patient’S Outcome ◽  
Gcs Score

Abstract: Stroke patients with decreased consciousness, airway disorders, hypoxia, apnea or therapeutic initiation of hyperventilation must be intubated. The delay in intubation time in stroke patients with a deteriorating general condition is very dangerous because it is related to higher mortality within the first 24 to 48 hours and will affect the length of stay (LOS). One of the indications for intubation in stroke patients is the decrease in consciousness, namely the Glasgow Coma Scale (GCS) score <9. Albeit, intubation and mechanical ventilation can cause a person 6 to 21 times more likely to develop pneumonia, commonly referred to as ventilator associated pneumonia (VAP). This study was conducted at Prof. Dr. R. D. Kandou Hospital Manado and was aimed to obtain the correlation between time of intubation and stroke patient’s outcome based on GCS, VAP, LOS, and mortality. The results showed that there was no relationship between time of intubation <48 hours or ≥48 hours after stroke and improvement of GCS (0%); between time of intubation <48 hours or ≥48 hours after stroke and the occurence of VAP (P=0.698); and between time of intubation <48 hours or ≥48 hours after stroke and LOS (r=0.265; P=0.054); as well as between time of intubation <48 hours or ≥48 hours after stroke and mortality in the first two days after intubation (P=0.313).Keywords: stroke, time of intubation, outcome. Abstrak: Pasien stroke dengan penurunan kesadaran, gangguan jalan napas, hipoksia, apnea atau inisiasi terapetik hiperventilasi harus diintubasi. Penundaan waktu tindakan intubasi pada pasien stroke dengan keadaan umum yang memburuk sangat berisiko karena berkaitan dengan mortalitas dalam waktu 24-48 jam pertama dan akan memengaruhi length of stay (LOS). Indikasi dilakukannya intubasi terhadap pasien stroke salah satunya ialah penurunan kesadaran yang dinilai dengan skor Glasgow Coma Scale (GCS) <9. Intubasi dan ventilasi mekanik dapat menyebabkan seseorang 6 sampai 21 kali lipat cenderung terkena pneumonia (ventilator associated pneumonia/VAP). Penelitian ini bertujuan untuk mendapatkan hubungan antara waktu tindakan intubasi dengan outcome pasien stroke di RSUP Prof. Dr. R. D. Kandou Manado dengan menggunakan kajian terhadap GCS, VAP, LOS, dan angka kematian. Hasil penelitian memperlihatkan tidak terdapat hubungan antara waktu tindakan intubasi <48 jam atau ≥48 jam setelah serangan stroke dengan perbaikan GCS (0%); dengan kejadian VAP (P=0,698); dengan LOS (r=0,265; P=0,054); dan dengan angka kematian pada 2 hari pertama setelah diintubasi (P=0,313).Kata kunci: stroke, waktu tindakan intubasi, outcome

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

scholarly journals Hemogram as marker of in-hospital mortality in COVID-19

2021 ◽  
pp. jim-2021-001810
Author(s):  
Alejandro López-Escobar ◽  
Rodrigo Madurga ◽  
José María Castellano ◽  
Santiago Ruiz de Aguiar ◽  
Sara Velázquez ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admission ◽  
White Blood Cells ◽  
Rate Of Change ◽  
Hospital Death ◽  
Direct Role ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Rate Of Increase ◽  
Increased Risk

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

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