Predictors of Functional Outcome at Three Months Post Stroke in a Third Level Hospital in Ouagadougou Burkina Faso

Abstract

Aim/Background: The aim of our study was to identify the predictive factors of functional outcome at 3 months post stroke, at Tingandogo University Hospital, in Ouagadougou, Burkina Faso, in order to contribute to the improvement of the functional prognosis of patients suffering from stroke. Materials and methods: This involved a hospital study, longitudinal prospective and anaytical, of patients hospitalized for stroke, from March 2015 to February 2016, at the Tingandogo University Hospital, in Ouagadougou, then followed in outpatient neurology, for at least 3 months, after discharge from hospital. The sociodemographic, clinical and CT characteristics of the patients on admission, the mortality at 3 months, and the evaluation of the functional outcome of the survivors at 3 months by the modified Rankin score (mRS) were analyzed. Motor functional outcome was considered favorable if mRS ≤ 2 and unfavorable if mRS ≥ 3. Multivariate analysis with logistic regression made it possible to identify independent predictors of functional outcome at 3 months post-stroke. Results: A total of 232 patients were collected, i.e. 62.9% of cerebral infarction and 37.1% of intracerebral hemorrhage, with a male predominance (62.93%), an average age of 60.9 years +/- 14.5 years. On admission, 6% of patients were in a coma and 35.8% had severe to very severe neurological impairment. Motor physiotherapy indicated in 77.3% of patients was but only performed in 47.4% At 3 months post stroke, 27 patients had died (31%). Among the 160 surviving patients, 91 patients (56.9%) were autonomous or independent (mRS≤2) and 69 patients (43.1%) were still dependent (mRS≥3). The independent predictors of unfavorable functional outcome (mRS≥3) at 3 months post-stroke were: age ≥ 60 years (p = 0.007), pre-stroke disability (p = 0.032), severe neurological deficit at admission (p = 0.018), impaired alertness on admission (p = 0.005) and large infarcts (p=0.004). Conclusion: Advanced age, pre-stroke disability, clinical and CT markers of the extent of brain damage, influence functional outcome at 3 months post-stroke in our context. Improving the quality of care for all patients, even the oldest, and better access to quality functional rehabilitation will help improve the functional prognosis of stroke patients.