Palliative care after stroke
Stroke is the leading cause of disability and one of the most common reasons of death around the world. Information is not sufficient on the palliative care (PC) needs of stroke patients and factors affecting their prognosis. In this study, we have investigated the demographics and comorbidities of stroke patients followed-up in a PC center (PCC), and the factors efficient on their prognosis. Medical records of 132 patients followed-up in PCC with stroke diagnosis between years 2016 and 2017 were reviewed retrospectively. Patients diagnosed with stroke were grouped as ischemic stroke, intracerebral hematoma (ICH) and subarachnoid hemorrhage (SAH). Age, gender, PCC hospitalization period (LOS), Glasgow Coma Scale, comorbidities such as percutaneous endoscopic gastrostomy, tracheostomy, pressure ulcer (PU), and discharge status (home, intensive care unit, exitus) have been compared for the patients included in the study. While average age was 72.41 ± 16.03 and hospitalization period was 35.47 ± 36.13 days, 92 patients (69.7%) were diagnosed with ischemic stroke, 20 patients (15.2%) with ICH, and 20 patients (15.2%) were diagnosed with SAH. The rate of exitus in patients diagnosed with ischemic stroke was significantly higher than patients diagnosed with ICH and SAH (p = 0.02), and hypertension rate was higher in patients with ischemic stroke than patients diagnosed with SAH (p = 0.007). The age of patients with exitus were found to be significantly higher (p = 0.001). Length of stay (LOS) in PC was determined to be significantly higher in patients with tracheostomy and patients diagnosed with ICH compared to patients with SAH. Furthermore, PU rate was significantly higher in patients diagnosed with ICH than patients with SAH (p = 0.007). Patients who experienced stroke and their families need comprehensive palliative care for psychosocial support, determination of patient-focused care objectives, and symptom management. There is a need for studies on larger populations to eliminate prognostic uncertainties and provide successful symptom management in patients following stroke.
KeywordsPalliative care Ischemic stroke ICH
GS, DA and KK collected and integrated the data. GS and KK conceived and designed the study. GS, DA and KK analyzed the data, wrote and reviewed the paper, and were responsible for statistical analysis. All authors approved the final version of this paper for publication.
No funding sources.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study were in accordance with the ethical standards of the Medical Ethical Committee at the Ankara Numune Training and Research Hospital (dated 26.6.2018 and approval no: E-18-2080) and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.World Health Organization (WHO) WHO Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en/. Accessed 2 Jul 2018
- 5.Mozaffarian D et al (2015) Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation 131(4):e29–e322Google Scholar
- 10.Lindsay MP et al (2014) Canadian stroke best practice recommendations. Heart and Stroke Foundation, Ottawa. http://www.strokebestpractices.ca. Accessed 27 Jul 2014
- 13.Go AS et al (2014) Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation 129(3):e28–e292Google Scholar
- 19.Heron M (2016) Deaths: leading causes for 2013. Natl Vital Stat Rep 65(2):1–95Google Scholar
- 27.Allman RM (1998) The impact of pressure ulcers on health care costs and mortality. Adv Wound Care 11(3 Suppl):2Google Scholar
- 30.Bosel J et al (2012) Benefits of early tracheostomy in ventilated stroke patients? Current evidence and study protocol of the randomized pilot trial SETPOINT (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial). Int J Stroke 7(2):173–182CrossRefGoogle Scholar