Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: A clinical audit

Mohammed N Alkhatib, Tamer Abd-Alghafoor, AlaaEldeen Elmassry, Loai Albarqouni, Bettina Böttcher, Maha Alfaqawi

Research output: Contribution to journalMeeting AbstractResearchpeer-review

Abstract

BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. FINDINGS: Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients. INTERPRETATION: No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further.None.

Original languageEnglish
Pages (from-to)S28
Number of pages1
JournalThe Lancet
Volume391
Issue numberS2
DOIs
Publication statusPublished - 21 Feb 2018
EventThe Lancet Palestinian Health Alliance Eighth Annual Conference: Health of Palestinians - Birzeit, Palestine, State of
Duration: 15 Mar 201716 Mar 2017
Conference number: 8th
http://icph.birzeit.edu/events/lpha-eighth-annual-conference-march-15-16-2017

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Clinical Audit
Middle East
Stroke
Guidelines

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Alkhatib, M. N., Abd-Alghafoor, T., Elmassry, A., Albarqouni, L., Böttcher, B., & Alfaqawi, M. (2018). Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: A clinical audit. The Lancet, 391(S2), S28. https://doi.org/10.1016/S0140-6736(18)30394-5
Alkhatib, Mohammed N ; Abd-Alghafoor, Tamer ; Elmassry, AlaaEldeen ; Albarqouni, Loai ; Böttcher, Bettina ; Alfaqawi, Maha. / Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip : A clinical audit. In: The Lancet. 2018 ; Vol. 391, No. S2. pp. S28.
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abstract = "BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. FINDINGS: Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54{\%}) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91{\%}) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92{\%}) patients, electrocardiography for 85 (89{\%}) patients, carotid duplex ultrasound for 32 (34{\%}) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74{\%}) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85{\%}) patients received venous thromboembolism prophylaxis. 41 (43{\%}) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43{\%}) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48{\%}) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57{\%}) patients. INTERPRETATION: No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further.None.",
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Alkhatib, MN, Abd-Alghafoor, T, Elmassry, A, Albarqouni, L, Böttcher, B & Alfaqawi, M 2018, 'Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: A clinical audit' The Lancet, vol. 391, no. S2, pp. S28. https://doi.org/10.1016/S0140-6736(18)30394-5

Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip : A clinical audit. / Alkhatib, Mohammed N; Abd-Alghafoor, Tamer; Elmassry, AlaaEldeen; Albarqouni, Loai; Böttcher, Bettina; Alfaqawi, Maha.

In: The Lancet, Vol. 391, No. S2, 21.02.2018, p. S28.

Research output: Contribution to journalMeeting AbstractResearchpeer-review

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T1 - Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip

T2 - A clinical audit

AU - Alkhatib, Mohammed N

AU - Abd-Alghafoor, Tamer

AU - Elmassry, AlaaEldeen

AU - Albarqouni, Loai

AU - Böttcher, Bettina

AU - Alfaqawi, Maha

PY - 2018/2/21

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N2 - BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. FINDINGS: Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients. INTERPRETATION: No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further.None.

AB - BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. FINDINGS: Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients. INTERPRETATION: No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further.None.

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