The management of acute stroke on Montserrat

ABSTRACT

OBJECTIVE: To assess the management of acute stroke on Montserrat over a sixteen (16) year period in order to highlight areas in which the quality of the service provided can be improved.DESIGN AND METHODS: Forty five patients were studied from a sample frame of 117. Mean age 70 (range 38-100) of whom 29 (64%) were male. A data collection sheet was designed. Information was collected on areas of patient management. Logrank and Cox regression methods were used to test association between survival after stroke and other independent factors. RESULTS: Only 7% of patients (3) had a CT scan. All 3 had the scan within 24 hours. 49% of patients received Aspirin without a CT Diagnosis. Having Glasgow Coma Scale (GCS) <13 (p <0.001), papilledema or neck stiffness (p = 0.003), receiving oxygen for having an oxygen saturation <95% (p = 0.041) and having a swallow assessment (p<0.001) were negatively associated with survival. The estimated median survival time was 1.1 years. CONCLUSION: Access to CT scanning was a problem for patients with acute stroke on Montserrat. Providing CT scanning locally would allow for long term cost reductions and is likely to reduce morbidity and mortality from stroke. This, in combination with Stoke-unit quality ward care, may improve the median survival time.