Readmission and mortality during the first year after an acute stroke: A prospective cohort study from Cameroon

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BACKGROUND: Hospital readmission after discharge for stroke is associated with high morbidity and mortality. There is a paucity of data on the burden of stroke readmission in most sub-Saharan African countries. We aimed to determine the rate, reasons and predictors of hospital readmission and the mortality rate within 12 months of discharge among stroke survivors in Cameroon. METHODS: This prospective cohort included patients who survived hospitalization for an acute stroke and who were discharged from two referral hospitals in the capital city of Cameroon between January 2013 and December 2013.We performed logistic regression analysis to identify demographic and clinical factors associated with readmission within 1 year of discharge and causes of readmission. RESULTS: Of the 254 consecutive patients admitted for acute stroke, 198 were discharged alive. There were 107 (54%) males, and their mean age (SD) was 61.7 (13.9) years (range: 10 to 95 years). A total of 30 (15.2%) patients were readmitted following discharge from the index admission over a mean follow-up time of 286.9 (127.6) days. Of these, 14 (46.7%) were discharged and 16 (53.3%) died after readmission. Thirty percent (30%) of readmissions occurred within the first month. The most frequent causes of readmissions were infections (30%) and recurrent stroke (26.7%). Factors associated with readmission in bivariate analysis were initial admission temperature > 37.5°C (risk ratio [RR]: 1.3, p = 0.021) and initial admission Glasgow Coma Score < 14 (RR: p = 1.23, p = 0.019). After stratified adjustment for age and sex, temperature > 37.5°C (adjusted RR: 1.3, 95% CI: 1-1.7, p = 0.036) and GCS <14 (adjusted RR: 1.23, 95% CI: 1-1.6, p = 0.041) were associated with readmission. CONCLUSION: Readmission after discharge for stroke was common with nearly one third occurring within the first month and more than half dying following readmission. The most common causes of readmission were infections and recurrent stroke.

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