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Palliative care after stroke

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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.

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References

  1. World Health Organization (WHO) WHO Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en/. Accessed 2 Jul 2018

  2. Boersma I et al (2014) Palliative care and neurology: time for a paradigm shift. Neurology 83(6):561–567

    Article  PubMed  PubMed Central  Google Scholar 

  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):1887–1916

    Article  PubMed  Google Scholar 

  4. Lorenzl S et al (2013) Palliative treatment of chronic neurologic disorders. Handb Clin Neurol 118:133–139

    Article  PubMed  Google Scholar 

  5. Mozaffarian D et al (2015) Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation 131(4):e29–e322

    PubMed  Google Scholar 

  6. Koton S et al (2014) Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA 312(3):259–268

    Article  CAS  PubMed  Google Scholar 

  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):2080–2086

    Article  CAS  PubMed  Google Scholar 

  8. Robinson MT, Holloway RG (2017) Palliative care in neurology. Mayo Clin Proc 92(10):1592–1601

    Article  PubMed  Google Scholar 

  9. Creutzfeldt CJ, Longstreth WT, Holloway RG (2015) Predicting decline and survival in severe acute brain injury: the fourth trajectory. BMJ 351:h3904

    Article  PubMed  Google 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

  11. Gardiner C et al (2013) Provision of palliative and end-of-life care in stroke units: a qualitative study. Palliat Med 27(9):855–860

    Article  PubMed  Google Scholar 

  12. Stevens T et al (2007) Palliative care in stroke: a critical review of the literature. Palliat Med 21(4):323–331

    Article  CAS  PubMed  Google Scholar 

  13. Go AS et al (2014) Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation 129(3):e28–e292

    Google Scholar 

  14. Burton CR et al (2010) The palliative care needs of acute stroke patients: a prospective study of hospital admissions. Age Ageing 39(5):554–559

    Article  PubMed  Google Scholar 

  15. Blacquiere D et al (2013) Satisfaction with palliative care after stroke: a prospective cohort study. Stroke 44(9):2617–2619

    Article  PubMed  Google Scholar 

  16. Creutzfeldt CJ, Holloway RG, Walker M (2012) Symptomatic and palliative care for stroke survivors. J Gen Intern Med 27(7):853–860

    Article  PubMed  PubMed Central  Google Scholar 

  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):47–54

    Article  PubMed  Google Scholar 

  18. Roberts SE et al (2015) Mortality following stroke, the weekend effect and related factors: record linkage study. PLoS One 10(6):e0131836

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Heron M (2016) Deaths: leading causes for 2013. Natl Vital Stat Rep 65(2):1–95

    PubMed  Google Scholar 

  20. Alonso A et al (2015) Outcome predictors of acute stroke patients in need of intensive care treatment. Cerebrovasc Dis 40(1–2):10–17

    Article  PubMed  Google Scholar 

  21. Abanto C et al (2013) Predictors of functional outcome among stroke patients in Lima, Peru. J Stroke Cerebrovasc Dis 22(7):1156–1162

    Article  PubMed  PubMed Central  Google Scholar 

  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):526–530

    Article  PubMed  Google Scholar 

  23. Koton S et al (2010) Derivation and validation of the prolonged length of stay score in acute stroke patients. Neurology 74(19):1511–1516

    Article  CAS  PubMed  Google Scholar 

  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):2534–2540

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wang Y et al (2003) A prediction model of 1-year mortality for acute ischemic stroke patients. Arch Phys Med Rehabil 84(7):1006–1011

    Article  PubMed  Google Scholar 

  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):1603–1608

    Article  PubMed  Google Scholar 

  27. Allman RM (1998) The impact of pressure ulcers on health care costs and mortality. Adv Wound Care 11(3 Suppl):2

    CAS  PubMed  Google Scholar 

  28. Holloway RG et al (2005) Prognosis and decision making in severe stroke. JAMA 294(6):725–733

    Article  CAS  PubMed  Google Scholar 

  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):2651–2656

    Article  PubMed  Google 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):173–182

    Article  PubMed  Google Scholar 

  31. Pan CX et al (2015) Impact of a palliative care program on tracheostomy utilization in a community hospital. J Palliat Med 18(12):1070–1073

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology Clinic, Ankara Ulus State Hospital, Gayret Sok. No:6, Ankara, Turkey

    Gülhan Saricam

  2. Department of Clinic Microbiology, Ankara Ulus State Hospital, Ankara, Turkey

    Dogan Akdogan

  3. Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Numune Training and Research Hospital, Ankara, Turkey

    Kadriye Kahveci

Authors
  1. Gülhan Saricam
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  2. Dogan Akdogan
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  3. Kadriye Kahveci
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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.

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Correspondence to Gülhan Saricam.

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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.

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Saricam, G., Akdogan, D. & Kahveci, K. Palliative care after stroke. Acta Neurol Belg 119, 69–75 (2019). https://doi.org/10.1007/s13760-018-1047-0

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  • DOI: https://doi.org/10.1007/s13760-018-1047-0

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