Counting the cost of hospital admissions with stroke in the Port-of-Spain and San Fernando, Trinidad

ABSTRACT

Cerebrovascular disease is one of the leading causes of death in Caribbean countries, but few studies have examined the use of hospital services by people suffering from stroke. We studied all patients admitted to Port-of-Spain and San Fernando hospitals in Trinidad over a twelve-month period. There were 643 admissions at Port-of-Spain Hospital and 462 at San Fernando. There were 823 (74 percent) admissions with first time strokes and 282 (26 percent) admissions with recurrent stroke; 321 (29 percent) were aged 65-74 years and 324 (29 percent) were 75 years of age. Five hundred and nine (46 percent) were Afro-Trinidadian and 418 (38 percent) Indo-Trinidadian but ethnic distribution differed at the two hospitals. There were clinical diagnoses of hypertension in 693 (63 percent) and diabetes mellitus in 355 (32 percent). There were 322 deaths giving a hospital admission fatality rate of 29 percent (95 percent CI, 26-32 percent). Mortality was associated with level of consciousness and degree of impairment of speech, swallowing and continence at the time of first assessment. Hospital mortality was not associated with age, gender, ethnic group or hospital of treatment. Among surviving patients 444 (57 percent) were severely disabled at the time of discharge. The median length of stay was 4 days (interquartile range 2-8 days) at Port-of-Spain and 5(3-9) days at San Fernando. At the two hospitals admissions with stroke accounted for 9088 bed-days annually with a conservatively estimated hospital cost in excess of TT $3.6 million (US$ 0.63). We conclude that stroke imposes a significant burden on hospital services, the hospital mortality rate is high and survivors have significant disability. The high prevalence of hypertension in stroke sufferers points to a strategy for control of stroke (AU)