Table 2.
Determining the implementation and largest impact of stroke interventions at Muhimbili National Hospital (MNH). GWTG (Get with the Guidelines, US-based registry), DVT (deep vein thrombosis), ppx (prophylaxis), SCD (sequential compression device), ASA (aspirin), ACEi (ACE inhibitor), AF (atrial fibrillation), CEA (carotid endarterectomy), tPA (tissue plasminogen activator), mRS (modified Rankin score), ET (endovascular thrombectomy).
| Ischemic stroke intervention* | % Implemented at MNH** | % Implemented in GWTG [Reference] | Trial [Reference] | Absolute risk reduction (%) | Number needed to treat |
|---|---|---|---|---|---|
| Early dysphagia screen (24/7), Pneumonia during admission | 80 | 68 [35] | EDS [11] | 12−3.8 = 8.2 | 12.8 |
| DVT ppx in 7 days, DVT during admission | 0 | 89 [35] | LMWH [39] | 28−4 = 24 | 4.2 |
| SCD in 12 h, DVT during admission | 0 | N/A | SCD [13] | 9.2−0.2 = 9 | 11.1 |
| ASA in 48 h, 14 days recurrent stroke | 83 | 92 [40] | IST [14] | 3.9−2.8 = 1.1 | 100 |
| ASA for stroke history, 3 years vascular event | 83 | 98 [40] | ATC [15] | 22−18 = 4 | 26.3 |
| Atorvastatin in 6 months, 5 years recurrent stroke | 95 | 83 [40] | SPARCL [16] | 13−11 = 2 | 52.6 |
| ACEi+/-diuretic after 2 weeks, 4 years recurrent stroke | 89 | 80 [40] | PROGRESS [17] | 14−10 = 4 | 26.7 |
| Warfarin-adjusted vs. ASA/Warfarin-fixed for AF history, 1 year recurrent stroke | 50 | 94 [40] | SPAF III [18] | 7.9−1.9 = 6 | 16.7 |
| CEA for carotid stenosis in 120 days, 2 years recurrent stroke | 0 | N/A | NASCET [20] | 26−9 = 17 | 5.9 |
| tPA in 3 h, 90 days mRS 2–6 | 0 | 60 [35] | NINDS [21] | 73−61 = 12 | 8.3 |
| tPA in 4.5 h, 90 days mRS 2–6 | 0 | 60 [35] | ECASS III [22] | 55−48 = 7 | 13.5 |
| ET in 6 h, 90 days mRS 2–6 | 0 | 27 [41] | HERMES [24] | 87−73 = 14 | 7.1 |
*Intervention, outcome.
**For implementation at MNH at the time of discharge, 54/65 were on an antiplatelet agent, 3/57 anticoagulation, 52/55 statin, 50/56 antihypertensive, 52/64 underwent dysphagia screen. References in brackets