Stroke: A retrospective review of the incidence and epidemiology in a South African academic hospital emergency department

Abstract

Background. Stroke is a leading cause of morbidity and mortality. Most deaths occur in low- and middle-income countries, with the incidence predicted to increase as populations undergo socioeconomic and epidemiological changes. Knowledge of contributing factors in a South African (SA) population can be used to drive healthcare initiatives to modify this burden of disease.

Objectives. To analyse epidemiological data on patients with stroke presenting to an emergency department in Johannesburg, SA.

Methods. The study was a 12-month descriptive, retrospective review of medical records, undertaken at a tertiary-level hospital. Patients’ records were selected based on the presumptive diagnosis of stroke. Data collected included ethnicity, age, gender, risk factors, signs and symptoms at presentation, and computed tomography (CT) brain scan findings.

Results. Of 312 records reviewed, 160 were eligible for inclusion. The mean age of the patients included was 57.7 years, and 64 patients (40%) had CT-confirmed haemorrhagic strokes. Hypertension was the most common comorbidity/risk factor identified, in the sample as a whole (n=93; 58%) and in both patients with haemorrhagic (n=33; 52%) and ischaemic strokes (n=56; 61%). Diabetes was the second most common comorbidity/risk factor (n=23; 14%), and was three times more likely in patients with ischaemic strokes (n=19; 20%) compared with haemorrhagic strokes (n=4; 6%).

Conclusions. Stroke is an important healthcare concern for SA. Our study demonstrated a lower mean age of patients presenting with stroke compared with high- and upper middle-income countries, and a higher proportion of haemorrhagic strokes. Several modifiable risk factors such as hypertension and diabetes were identified. Data collection on a regional and national level is important to drive targeted healthcare initiatives.