Case fatality of patients with stroke over a 12-month period post stroke.

INTRODUCTION: Stroke is among the top 4 causes of death in South Africa and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital. METHODS: A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature. RESULTS: Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died. CONCLUSION: The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores.

Health-related quality of life of survivors of penetrating trunk trauma in Johannesburg, South Africa.

PURPOSE: To study how the health-related quality of life (HRQOL) of survivors of penetrating trunk trauma (PTT) changes from pre-morbid status to 6 months after hospital discharge and to determine differences in the HRQOL between subjects ventilated for short and prolonged periods of time. To determine how the HRQOL of PTT survivors compares with that of a healthy control group in order to identify limitations imposed by critical illness. METHODS: Retrospective and observational prospective assessment of the quality of life (QoL) of PTT survivors with the Medical Outcomes Short Form-36 (SF-36) UK English version questionnaire. Cross-sectional assessment of the QoL of a healthy control group with the SF-36. RESULTS: The physical component summary (PCS) score was significantly reduced for the short mechanical ventilation (MV) group (n = 13) at 1 and 3 months compared to pre-admission status (p = 0.00, respectively). The mental component summary (MCS) score was significantly reduced at 1, 3 and 6 months (p = 0.00, respectively). The PCS and MCS were significantly reduced for the long MV group (n = 29) at all three assessments compared to the pre-admission HRQOL (p = 0.00-0.01). The short MV group reported HRQOL comparable to that of the healthy group (n = 40) at 6 months after discharge. The long MV group had a significant reduction in the PCS at 1, 3 and 6 months compared to the healthy group (p = 0.00, respectively). The long MV group had significantly reduced PCS at 3 and 6 months compared to the short MV group (p = 0.01 and 0.00, respectively). CONCLUSIONS: Subjects who had higher morbidity and prolonged MV suffered from reduced HRQOL related to physical health for up to 6 months after discharge.

Effect of penetrating trunk trauma on the recovery of adult survivors: a pilot study.

Gunshot and/or stab wounds to the trunk are injuries seen in South African hospitals. Patients are managed in the intensive care unit. Prolonged mechanical ventilation with immobilization results in some degree of muscle dysfunction. Our goal was to determine if patients recover adequately spontaneously following critical illness. No formal rehabilitation programmes exist in South Africa for these patients following discharge. A prospective, observational study was conducted. Patients were recruited from three ICUs in Johannesburg. Lung function tests, dynamometry, quality of life, 6-minute-walk, and oxygen uptake tests were performed over 6 months following discharge from the hospital. The control group consisted of existing data for healthy volunteers. Distance walked during 6-minute-walk test was significantly reduced for the study group compared to the control group (1 month [p = 0.00251]; 6 months [p = 0.0355]). At 1 month there was a significant reduction in quadriceps and triceps strength for the study group compared to the control group (p = 0.0089; p = 0.0246, respectively). Quadriceps strength remained significantly reduced for the study group (3 months [p = 0.0489]). No difference in muscle strength was detected between the groups at 6 months. Actual and predicted residual volumes differed significantly for the study group (1 month [p = 0.0034]; 6 months [p = 0.0157]). A trend of muscle weakness (to 3 months), poor exercise capacity, and abnormal lung volumes was identified. A formal rehabilitation programme may be needed to address these disabilities.