PREDICTORS OF 48-HOURS MORTALITY AMONG PATIENTS WITH HEMORRHAGIC STROKE PRESENTING TO THE EMERGENCY MEDICINE DEPARTMENT OF MUHIMBILI NATIONAL HOSPITAL.

Abstract

Background: Hemorrhagic stroke is a cerebral vascular accident with bleeding into the brain, having a high mortality rate if immediate intervention is not done. Identifying predictors of mortality among patients with hemorrhagic stroke is important to maximize favorable patient outcomes.

Objective: To determine the predictors of 48-hour mortality among hemorrhagic stroke patients presenting to the Emergency Medicine Department of Muhimbili National Hospital (MNH-EMD-Mloganzila)

 Methodology: This was a prospective observational cohort study of adult hemorrhagic stroke patients presenting to the MNH-EMD between November 2023 to February 2024. A structured online case report form was used to document demographics, clinical presentation, Computed tomography findings, management given, disposition and outcome of patient presented to the Emergency, Medicine of MNH-Mloganzila. The primary outcome was predictors of 48 hours-mortality among hemorrhagic stroke patients, and the secondary outcome was their 48-hour mortality. Logistic regression was conducted to determine independent predictors of mortality.

Results: We enrolled 206 hemorrhagic stroke patients, whose mean age was 57(±14) years, and 128(62.1%) were males.  Most of them were referred from other facilities 192(93.2%). Most of them, 180/206 (87.4%) had hypertension, and the majority 199/206(96.6%) presented with sudden onset of one-sided limb weakness. Altered mentation and mouth deviation were observed in 94(45.6%) and 74(35.9%) respectively. In-hospital mortality at 48 hours was 26(12.6%). Requirement of oral airways on arrival was found to be the only independent predictor of 48-hour mortality from this study, (cOR=7.73, 95% CI 3.21-18.61, P value < 0.001).

Conclusion: The mortality among hemorrhagic stroke patients presenting to the EMD was high.  The patient’s need for an oral airway due to the inability to protect the airway was an independent predictor of mortality. Thus, hemorrhagic stroke patients who tolerate oral pharyngeal airway should be closely monitored preferably in the intensive care unit since they have a high likelihood of dying.