title: A prospective cohort study of stroke characteristics, care, and mortality in a hospital stroke registry in Vietnam.
abstract: BACKGROUND
  As low and middle-income countries such as Vietnam experience the health transition from infectious to chronic diseases, the morbidity and mortality from stroke will rise. In line with the recommendation of the Institute of Medicine's report on "Promoting Cardiovascular Health in the Developing World" to "improve local data", we sought to investigate patient characteristics and clinical predictors of mortality among stroke inpatients at Da Nang Hospital in Vietnam.
  
  
  METHODS
  A stroke registry was developed and implemented at Da Nang Hospital utilizing the World Health Organization's Stroke STEPS instrument for data collection.
  
  
  RESULTS
  754 patients were hospitalized for stroke from March 2010 through February 2011 and admitted to either the intensive care unit or cardiology ward. Mean age was 65 years, and 39% were female. Nearly 50% of strokes were hemorrhagic. At 28-day follow-up, 51.0% of patients with hemorrhagic stroke died whereas 20.3% of patients with ischemic stroke died. A number of factors were independently associated with 28-day mortality; the two strongest independent predictors were depressed level of consciousness on presentation and hemorrhagic stroke type. While virtually all patients completed a CT during the admission, evidence-based processes of care such as anti-thrombotic therapy and carotid ultrasound for ischemic stroke patients were underutilized.
  
  
  CONCLUSIONS
  This cohort study highlights the high mortality due in part to the large proportion of hemorrhagic strokes in Vietnam. Lack of hypertension awareness and standards of care exacerbated clinical outcomes. Numerous opportunities for simple, inexpensive interventions to improve outcomes or reduce recurrent stroke have been identified.
authors.affiliation: Department of Neurology, Harborview Medical Center, Room 3EH70, 325 Ninth Avenue, Seattle, WA 98104, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Tirschwell
authors.forename: Thanh G N
authors.initials: TG
authors.lastname: Ton
authors.forename: Kiet A
authors.initials: KA
authors.lastname: Ly
authors.forename: Quang
authors.initials: Q
authors.lastname: Van Ngo
authors.forename: Tung T
authors.initials: TT
authors.lastname: Vo
authors.forename: Chien Hung
authors.initials: CH
authors.lastname: Pham
authors.forename: William T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Annette L
authors.initials: AL
authors.lastname: Fitzpatrick
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014744:Vietnam / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator