London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 629 537 Epidemiology of stroke Factors Associated with Mortality in Thai Stroke Patients K. Kongbunkiat1, K. Thepsuthammarat2, N. Kasemsap3, K. Sawanyawisuth4, S. Tiamkao5 Division of Neurology, Internal Medicine Department, Faculty of Medicine, Khon Kaen Uni-versity, Khon Kaen, THAILAND1, Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, THAILAND2, Division of Neurology, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, THAILAND3, Division of Ambulatory Medicine, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, THAILAND4, Division of Neurology, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, THAILAND5 Background: Cerebrovascular disease is an important cause of death and disability in Thailand.Fac-tors associated with mortality of cerebrovascular diseases are important information tool used by policy makers in setting strategies and improved management system. Methods: The authors analyzed the data from adult population by using in-patients information from the three health insurance coverage schemes in the fiscal year 2010 with 3 diseases groups as per ICD-10 coding (G45-transient cerebral ischemic attacks and related syndromes, I61-intracerebral hemorrhage and I63-cerebral infarction). The data were analyzed to obtain the number of patients, number of admissions, comorbidity, complication, rate of received intravenous thrombolysis, num-ber of hospital mortalities, mortality rates, factor associated with mortalities, expenditure in hospital and length of hospital stays. Results: The total number of cerebrovascular diseases on in-patients was 82,061 patients in 1 year. The prevalence of cerebral infarction was highest of three group (122/100,000 population). Rate of received intravenous thrombolysis was 1 %. Mortality rate was 7%. Factor associated with mortali-ties were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus and congestive heart failure.The expenditure per patient was 20,740 baht (about 516 Euros), and length of hospital stays was average 6.8 days. Conclusion: Factor associated with mortalities was complication especially infection and rate of re-ceived intravenous thrombolysis was low. 538 Epidemiology of stroke WHAT BARRIERS FOR A REHABILITATION CLINICAL TRIAL CAN TEACH US ABOUT PROFILES OF PATIENTS WITH STROKE IN A DEVELOPING COUNTRY A.B. CONFORTO1, S.M. ANJOS2, E.A. MELLO3, K.N. FERREIRO4, E.M. NAGAYA5, E.S. MELO6, F.I. REIS7, L.G. COHEN8 HOSPITAL DAS CLÍNICAS/ UNIVERSIDADE DE SÂO PAULO E INSTITUTO DE EN-SINO E PESQUISA ALBERT EINSTEIN, SÃOP AULO, BRAZIL1, HOSPITAL DAS CLIN-ICAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL2, HOSPITAL DAS CLINI-CAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL3, HOSPITAL DAS CLINICAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL4, HOSPITAL DAS CLINICAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL5, HOSPITAL DAS CLINICAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL6, HOSPITAL DAS CLINICAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL7, HOSPITAL DAS CLINICAS - UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, BRAZIL8 Background: Two thirds of strokes occur in low- and middle-income countries. The majority of re-habilitation studies have been performed in high-income countries. Differences between populations of patients can impact eligibility for participation in research. Our aim was to describe reasons for exclusion of patients from a rehabilitation clinical trial involving repetitive transcranial magnetic stimulation (rTMS) in patients in the subacute phase after stroke, in Brazil. Methods: Inclusion criteria: 18 to 80 years old; 5-45 days post-ischaemic stroke; contralateral hand paresis. Exclusion criteria: previous symptomatic stroke; contraindications to rTMS; other neurolog-ic diseases; severe chronic diseases; shoulder pain; deformity in the paretic upper limb; inability to provide informed consent. The protocol involved daily administration of either active or sham rTMS of the motor cortex of the unaffected hemisphere, followed by physical therapy, five days per week over two weeks. Results: A total of 875 patients were screened and 412 (47.1%) did not fulfill inclusion criteria. In the remaining 52.9% of the patients, 49.4% were excluded and only 31 (3.5%) were included. The most common reason for exclusion was history of previous stroke (41%), followed by severe chron-ic diseases (10%). Conclusion: Recurrent strokes are often excluded from rehabilitation clinical trials conducted in developed countries, and represented the main barrier for inclusion in the present study. The rate of recurrent stroke in patients screened for this protocol was substantially higher than rates reported in developed countries (20-30%). These results indicate that adjustments in study design, according to local profiles of patients with stroke, would be valuable to increase external validity of rehabilitation clinical trials in developing countries.
Karger_ESC London_2013
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