OUTCOMES OF STROKE PATIENTS IN A TERTIARY CARE HOSPITAL
DOI:
https://doi.org/10.71000/6mhzhe10Keywords:
Disability Evaluation, Early Ambulation, Hemorrhagic Stroke, Ischemic Stroke, Mortality, Rehabilitation, StrokeAbstract
Background: Stroke remains a major global cause of mortality and long-term disability, imposing substantial burdens on individuals, families, and healthcare systems. Tertiary care hospitals play a pivotal role in improving outcomes through specialized acute stroke services, advanced neuroimaging, and structured rehabilitation programs. Understanding short-term and intermediate recovery trajectories is essential for optimizing treatment pathways, guiding rehabilitation strategies, and identifying predictors of unfavourable outcomes within high-acuity clinical environments.
Objective: This study aimed to evaluate clinical outcomes, functional recovery, mortality patterns, and predictors of poor prognosis among stroke patients in a tertiary care hospital, with specific emphasis on the impact of early rehabilitation on recovery.
Methods: A prospective observational study was conducted over 12 months at the Pakistan Emirates Military Hospital, enrolling 130 adult patients admitted within 24 hours of symptom onset with confirmed ischemic or hemorrhagic stroke. Data included demographic characteristics, comorbidities, admission NIHSS scores, neuroimaging findings, therapeutic interventions, and Modified Rankin Scale (mRS) scores at discharge and at three months. Survival rates, readmissions, and rehabilitation status were also documented. Statistical analysis using SPSS (version 23) involved descriptive statistics, t-tests, chi-square tests, and logistic regression to identify prognostic factors associated with poor outcomes.
Results: Of the total patients, 75% presented with ischemic stroke and 25% with hemorrhagic stroke. In-hospital mortality was 10%. At discharge, 20% demonstrated good recovery (mRS 0–2), while 45% had moderate disability and 25% had severe disability. At three-month follow-up, good recovery increased to 35% and severe disability declined to 15%. Early physiotherapy yielded functional improvement in 65% of participants compared with 25% among those without rehabilitation. Higher NIHSS scores, atrial fibrillation, delayed hospital arrival beyond six hours, and hemorrhagic stroke subtype were significant predictors of poor outcomes.
Conclusion: Early rehabilitation significantly enhances functional recovery following stroke, while timely hospital arrival and initial stroke severity remain critical determinants of prognosis. Identifying high-risk patients enables tailored interventions that can substantially improve recovery trajectories in tertiary care settings.
References
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Neurology. 2021 Oct;20(10):795.
Wang, Y.J., Li, Z.X., Gu, H.Q., Zhai, Y., Jiang, Y., Zhao, X.Q., Wang, Y.L., Yang, X., Wang, C.J., Meng, X. and Li, H., 2020. China stroke statistics 2019: a report from the National center for healthcare quality management in neurological diseases, China national clinical research center for neurological diseases, the Chinese stroke association, National center for chronic and non-communicable disease control and prevention, Chinese center for disease control and prevention and Institute for global neuroscience and stroke collaborations. Stroke and vascular neurology, 5(3).
Iso H. Cardiovascular disease, a major global burden: Epidemiology of stroke and ischemic heart disease in Japan. Global Health & Medicine. 2021 Dec 31;3(6):358-64.
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, Abbasi-Kangevari M, Abd-Allah F, Abedi V, Abualhasan A. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology. 2021 Oct 1;20(10):795-820.
Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurological research and practice. 2020 Jun 16;2(1):17.
Todhunter-Brown A, Sellers CE, Baer GD, Choo PL, Cowie J, Cheyne JD, Langhorne P, Brown J, Morris J, Campbell P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database of Systematic Reviews. 2025(2).
Teasell R, Salbach NM, Foley N, Mountain A, Cameron JI, Jong AD, Acerra NE, Bastasi D, Carter SL, Fung J, Halabi ML. Canadian stroke best practice recommendations: rehabilitation, recovery, and community participation following stroke. Part one: rehabilitation and recovery following stroke; update 2019. International Journal of Stroke. 2020 Oct;15(7):763-88.
Stinear CM, Lang CE, Zeiler S, Byblow WD. Advances and challenges in stroke rehabilitation. The Lancet Neurology. 2020 Apr 1;19(4):348-60.
Lee KE, Choi M, Jeoung B. Effectiveness of rehabilitation exercise in improving physical function of stroke patients: a systematic review. International journal of environmental research and public health. 2022 Oct 5;19(19):12739.
Salvadori E, Papi G, Insalata G, Rinnoci V, Donnini I, Martini M, Falsini C, Hakiki B, Romoli A, Barbato C, Polcaro P. Comparison between ischemic and hemorrhagic strokes in functional outcome at discharge from an intensive rehabilitation hospital. Diagnostics. 2020 Dec 28;11(1):38.
Westendorp WF, Dames C, Nederkoorn PJ, Meisel A. Immunodepression, infections, and functional outcome in ischemic stroke. Stroke. 2022 May;53(5):1438-48.
Banda KJ, Chu H, Kang XL, Liu D, Pien LC, Jen HJ, Hsiao ST, Chou KR. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC geriatrics. 2022 May 13;22(1):420.
Andrade JB, Mohr JP, Lima FO, de Carvalho JJ, Barros LC, Nepomuceno CR, Ferrer JV, Silva GS. The role of hemorrhagic transformation in acute ischemic stroke upon clinical complications and outcomes. Journal of Stroke and Cerebrovascular Diseases. 2020 Aug 1;29(8):104898.
Huang S, Diao S, Wan Y. Application of machine learning methods in predicting functional recovery in ischemic stroke patients. InProceedings of the 1st International Scientific and Practical Conference, Innovative Scientific Research: Theory, Methodology, Practice 2024 Sep 3 (p. 240).
Moore JL, Nordvik JE, Erichsen A, Rosseland I, Bø E, Hornby TG, FIRST-Oslo Team. Implementation of high-intensity stepping training during inpatient stroke rehabilitation improves functional outcomes. Stroke. 2020 Feb;51(2):563-70.
Hobeanu C, Lavallée PC, Charles H, Labreuche J, Albers GW, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Molina CA, Rothwell PM. Risk of subsequent disabling or fatal stroke in patients with transient ischaemic attack or minor ischaemic stroke: an international, prospective cohort study. The Lancet Neurology. 2022 Oct 1;21(10):889-98.
Olive-Gadea M, Cano D, Rodrigo-Gisbert M, Muchada M, Montiel E, Baladas M, Sanchez-Gavilan E, Paredes C, Garcia-Tornel A, Rubiera M, Requena M. Redefining disability: patient-reported outcome measures after minor stroke and transient ischemic attack. Stroke. 2023 Jan;54(1):144-50.
Liu SY, Hsu YL, Tu YC, Lin CH, Wang SC, Lee YW, Shih YT, Chou MC, Lin CM. Functional outcome prediction of ischemic stroke patients with atrial fibrillation accepting post-acute care training. Frontiers in neurology. 2022 Sep 23;13:954212.
Su F, Xu W. Enhancing brain plasticity to promote stroke recovery. Frontiers in neurology. 2020 Oct 30;11:554089.
Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Schneeberg A, Yao J. Higher doses improve walking recovery during stroke inpatient rehabilitation. Stroke. 2020 Sep;51(9):2639-48.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Rida asghar , Abdul Aziz, Ehtisham ul Haq, Rabia Afroze, Qurrat-ul-Ain kalim, Uzma Fareed (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
