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Presentation, Management, and Outcomes of Acute Stroke in Palestine
Rasha Khatib, PhD; Assef M. Jawaadah, MD; Umaieyh Khammash, MD; Ahmed Babiker, MD; Mark D. Huffman, MD; Shyam Prabhakaran, MD
Background: Stroke is a leading cause of death and disability in the Middle East. Data on the uptake of evidence-based practices are limited in the region. We aimed to examine patterns of stroke presentation, management, and outcomes at public Palestinian hospitals.
Methods and Results-—Comprehensive data from all patients with acute stroke admitted to 2 public hospitals in the West Bank of Palestine were prospectively collected. Acute stroke presentation patterns, in-hospital evaluation and management, mortality, and stroke complications were evaluated. Data were available for 150 patients with acute stroke between September 2017 and May 2018. The mean (SD) age was 65 (14) years and 49% were women. Only 25% of patients utilized ambulance services for transportation to the hospital. All patient received head computed tomography scans, although few received other investigations such as magnetic resonance imaging (8%) or carotid Doppler (4%). Most patients with ischemic stroke received antiplatelet therapy (98%), although none received thrombolysis. Only 17% received physical therapy evaluation. In-hospital mortality was 12%, 23% of patients had at least 1 poststroke complication, and the median modified Rankin Score at discharge was 4 (interquartile range, 2–5).
Conclusions-—We identified high stroke mortality and discharge disability rates in Palestine. Key evidence-based gaps were highlighted, suggesting opportunities for quality improvement. ( J Am Heart Assoc. 2018;7:e010778. DOI: 10.1161/JAHA.118. 010778)
Key Words: acute care • acute stroke • low- and middle-income countries • managed care • Palestine • stroke delivery