CLINICAL CHARACTERISTIC AND BLOOD PRESSURE MANAGEMENT IN ACUTE STROKE PATIENTS IN MALAYSIA
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Abstract
Introduction: Clinical characteristics to differentiate stroke subtype may be helpful to make sound decision in managing blood pressure in clinically stroke patients. This is more important while en route patient to tertiary centre with neuroimaging facility and neurosciences services. The objective of this study is to determine the distinction between ischaemic and haemorrhagic stroke based on the clinical characteristics. Time of presentation was also calculated to determine the feasibility of thrombolytic therapy among stroke patients in Malaysia.
Methods: A cross-sectional observational study of all stroke patients presented to Hospital Kuala Lumpur from January 2005 to May 2005. All patients were subjected to brain CT. Clinical characteristics age, gender, loss of consciousness (LOC), headache, vomiting, Glasgow coma scale (GCS), systolic blood pressure and diastolic blood pressure were assessed. Time of presentation was also determined.
Results: A total of 143 patients (88 male and 55 female) were included. The mean age for haemorrhagic stroke was 51.1 ( 14.9) years old and mean age for ischaemic stroke was 56.8 ( 9.7) years old. Multiple logistic regression analysis shows three clinical characteristics were associated with ischaemic stroke male (adj. OR 0.18, 95% CI 0.05-0.59), headache (adj.OR 0.16, 95% CI 0.06-0.47), LOC (adj.OR 0.20, 95% CI 0.06-0.66), age in years (adj OR 1.06, 95% CI 1.01-1.11) and poor GCS (adj.OR 1.44, 95% CI 1.14-1.82). Only 4.9% patients presented less than 3 hours and most of them (64.3%) presented more than 6 hours.
Conclusion: Male patients with LOC, headache and poor GCS were the clinical characteristics of lower chance of having ischaemic stroke. BP in clinically stroke patient with this clinical characteristic should be lowered with a target of SBP ? 140mmHg. Increasing age and patients with good GCS were more likely to associate with ischaemic stroke. There was significant delayed of presentation for stroke patients. Many factors need to be improved to reduce the time of presentation in the future.