Advertisement

Acta Neurologica Belgica

, Volume 119, Issue 1, pp 69–75 | Cite as

Palliative care after stroke

  • Gülhan SaricamEmail author
  • Dogan Akdogan
  • Kadriye Kahveci
Original Article

Abstract

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.

Keywords

Palliative care Ischemic stroke ICH 

Notes

Author contributions

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.

Funding

No funding sources.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    World Health Organization (WHO) WHO Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en/. Accessed 2 Jul 2018
  2. 2.
    Boersma I et al (2014) Palliative care and neurology: time for a paradigm shift. Neurology 83(6):561–567CrossRefGoogle Scholar
  3. 3.
    Holloway RG et al (2014) Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45(6):1887–1916CrossRefGoogle Scholar
  4. 4.
    Lorenzl S et al (2013) Palliative treatment of chronic neurologic disorders. Handb Clin Neurol 118:133–139CrossRefGoogle Scholar
  5. 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
  6. 6.
    Koton S et al (2014) Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA 312(3):259–268CrossRefGoogle Scholar
  7. 7.
    Hankey GJ et al (2000) Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 31(9):2080–2086CrossRefGoogle Scholar
  8. 8.
    Robinson MT, Holloway RG (2017) Palliative care in neurology. Mayo Clin Proc 92(10):1592–1601CrossRefGoogle Scholar
  9. 9.
    Creutzfeldt CJ, Longstreth WT, Holloway RG (2015) Predicting decline and survival in severe acute brain injury: the fourth trajectory. BMJ 351:h3904CrossRefGoogle Scholar
  10. 10.
    Lindsay MP et al (2014) Canadian stroke best practice recommendations. Heart and Stroke Foundation, Ottawa. http://www.strokebestpractices.ca. Accessed 27 Jul 2014
  11. 11.
    Gardiner C et al (2013) Provision of palliative and end-of-life care in stroke units: a qualitative study. Palliat Med 27(9):855–860CrossRefGoogle Scholar
  12. 12.
    Stevens T et al (2007) Palliative care in stroke: a critical review of the literature. Palliat Med 21(4):323–331CrossRefGoogle Scholar
  13. 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
  14. 14.
    Burton CR et al (2010) The palliative care needs of acute stroke patients: a prospective study of hospital admissions. Age Ageing 39(5):554–559CrossRefGoogle Scholar
  15. 15.
    Blacquiere D et al (2013) Satisfaction with palliative care after stroke: a prospective cohort study. Stroke 44(9):2617–2619CrossRefGoogle Scholar
  16. 16.
    Creutzfeldt CJ, Holloway RG, Walker M (2012) Symptomatic and palliative care for stroke survivors. J Gen Intern Med 27(7):853–860CrossRefGoogle Scholar
  17. 17.
    Chen HF, Li CY, Lee SP, Kwok YT, Chu YT (2014) Improving the one-year mortality of stroke patients: an 18-year observation in a teaching hospital. Tohoku J Exp Med 232(1):47–54CrossRefGoogle Scholar
  18. 18.
    Roberts SE et al (2015) Mortality following stroke, the weekend effect and related factors: record linkage study. PLoS One 10(6):e0131836CrossRefGoogle Scholar
  19. 19.
    Heron M (2016) Deaths: leading causes for 2013. Natl Vital Stat Rep 65(2):1–95Google Scholar
  20. 20.
    Alonso A et al (2015) Outcome predictors of acute stroke patients in need of intensive care treatment. Cerebrovasc Dis 40(1–2):10–17CrossRefGoogle Scholar
  21. 21.
    Abanto C et al (2013) Predictors of functional outcome among stroke patients in Lima, Peru. J Stroke Cerebrovasc Dis 22(7):1156–1162CrossRefGoogle Scholar
  22. 22.
    Pham TM et al (2007) Mortality and risk factors for stroke and its subtypes in a cohort study in Japan. Prev Med 44(6):526–530CrossRefGoogle Scholar
  23. 23.
    Koton S et al (2010) Derivation and validation of the prolonged length of stay score in acute stroke patients. Neurology 74(19):1511–1516CrossRefGoogle Scholar
  24. 24.
    Singh T et al (2017) Palliative care for hospitalized patients with stroke: results from the 2010 to 2012 national inpatient sample. Stroke 48(9):2534–2540CrossRefGoogle Scholar
  25. 25.
    Wang Y et al (2003) A prediction model of 1-year mortality for acute ischemic stroke patients. Arch Phys Med Rehabil 84(7):1006–1011CrossRefGoogle Scholar
  26. 26.
    Lyder CH et al (2012) Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. J Am Geriatr Soc 60(9):1603–1608CrossRefGoogle Scholar
  27. 27.
    Allman RM (1998) The impact of pressure ulcers on health care costs and mortality. Adv Wound Care 11(3 Suppl):2Google Scholar
  28. 28.
    Holloway RG et al (2005) Prognosis and decision making in severe stroke. JAMA 294(6):725–733CrossRefGoogle Scholar
  29. 29.
    Roch A et al (2003) Long-term outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. Crit Care Med 31(11):2651–2656CrossRefGoogle Scholar
  30. 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
  31. 31.
    Pan CX et al (2015) Impact of a palliative care program on tracheostomy utilization in a community hospital. J Palliat Med 18(12):1070–1073CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2018

Authors and Affiliations

  1. 1.Department of Neurology ClinicAnkara Ulus State HospitalAnkaraTurkey
  2. 2.Department of Clinic MicrobiologyAnkara Ulus State HospitalAnkaraTurkey
  3. 3.Department of Anesthesiology and ReanimationUniversity of Health Sciences, Ankara Numune Training and Research HospitalAnkaraTurkey

Personalised recommendations