Management of Acute Stroke Among Lebanese Patients: Assessing Adherence to International Guidelines

Abstract

Background: Ischemic stroke accounts for around 87% of all strokes worldwide and is the second leading cause of mortality and a significant factor of disability in adults. The objective of this study was to assess the adherence to international treatment guidelines for ischemic stroke in Lebanese hospitals and evaluate factors associated with in-hospital mortality. Methods: This retrospective observational study was conducted in three Lebanese hospitals between January 2018 and December 2019. All adult patients diagnosed with ischemic stroke and who were subsequently admitted and treated in the internal medicine department, intensive care unit, or coronary care units were included in the study. Results: Out of 292 patients with stroke, 56.8% were females with hypertension being the most common previous disease (38.4%). Concerning acute management, 94.5% had an early brain imaging performed upon hospital presentation, 14.4% were eligible for emergency reperfusion, 2.1% were prescribed fibrinolytic therapy, 50% were adherent with acute hypertension treatment, and 6.2% were adherent with the antiplatelet regimen recommendation. The results highlight that right sided hemiparesis, decreased level of consciousness, and hyperthermia (T > 38°C) were significantly associated with in-hospital death. Guideline adherence for all the acute treatment measures and management strategies was 90.2%. Conclusion: The study highlights that guideline recommendations were not uniformly applied among all patients, and those recommendation standards set by the guidelines were not applied among all hospitals.