Haemorrhagic Stroke – Clinical and Social Impact A District General Hospital’s Experience

Abstract

Introduction and objectives – Haemorrhagic stroke is, in Portugal, unusually
prevalent. Its diverse nature assumes equally diverse clinical presentations. The author’s
objective was to characterise patients discharged, from the José Luciano Castro
Hospital - Anadia, with the diagnosis of haemorrhagic stroke, with respect to evolution
and post-discharge planning.
Patients and methodology – The clinical files of all patients admitted between 1994
and 1999 for subarachnoid and intracerebral haemorrhagic events, according to the
diagnosis-related groups (DRG) database (ICD-9, codes 430 and 431) were
retrospectively reviewed. The following data was recorded: age, sex, residential area,
mortality, hospital length of stay, co-morbidities, transferrals and post-discharge social
planning. This data was compared and correlated to the data on ischaemic stroke for the
same period.
Results – There were 155 admissions for haemorrhagic stroke, corresponding to 148
patients. The population was homogeneous where residential area was concerned and
accounted for 16.2% of all strokes. The average length of stay was 20.3 ± 14.1, longer
in patients with infectious complications (28.3 ± 17.8 for pneumonia, 31.3 ± 12.8 for
other infections) as well as for those with more than one comorbidity (32.0 ± 19.9). The
prevalence of prolonged hospitalisation was 6.5%. Complications during hospitalisation
occurred in 54.8% of the admissions, pneumonia being the most common complication
registered (18 patients). The mortality rate was 18.1%, often early in the hospital stay
(17.8% in the first day, 57.1% in the first six days) and mostly in the elderly. All these
indicators were worse in comparison to those recorded for ischaemic stroke. On
discharge social worker’s help was needed in 67.5% of cases.
Discussion – The seriousness of haemorrhagic stroke, obvious from the indicators
considered (mortality, average length of stay, transferral and comorbidities) is greater
than that of other strokes, and it affects younger populations. The need for post-discharge social planning in a large number of patients is also discussed. The significant
weight of these indicators and the increased hospital resources expenditure in these
cases, raises the question as to whether reimbursement should be the same as that for
ischaemic stroke events, as all stroke pathology is coded similarly (DRG 14) “Specific
cerebrovascular disorders, except TIA”