Correlation of Alberta stroke program early CT score among ischemic stroke patients and their outcomes at selected centres in Kampala.

Abstract

Introduction; Stroke is the second leading cause of death globally and contributes significantly to morbidity. It is important to know the etiology of stroke as secondary stroke prevention management differs. Neuroimaging is very important in confirmation of stroke. The Alberta Stroke Program Early Computed Tomography (ASPECT) Score; a 10-point scoring system with anatomical regions of the brain over the middle cerebral artery (MCA) territory is used to assess early ischemic changes on a head non-contrast CT (NCCT). This study sought to describe the correlation between the ASPECTS among ischemic stroke patients and their outcomes at selected centres in Kampala. Objectives: This study aimed to determine the correlation between the ASPECTS score and the outcomes of ischemic stroke patients in Kampala, Uganda Methodology: This was a prospective longitudinal observational study that was carried out in Mulago and Kiruddu National Referral Hospitals and St Francis Hospital Nsambya. All patients diagnosed with ischemic stroke involving the MCA territory as a first time diagnosis and had given informed consent to participate in the study, their head non-contrast head CT scans were evaluated to determine the ASPECT score. Study patients were recruited consecutively until the sample size of 120 patients was obtained, a one month follow up was done. Data Management and Analysis: STATA version 14.0 was used for data cleaning and analysis. Descriptive analysis was conducted to describe continuous variables. Spearman correlation analysis was carried out to measure the strength and direction of association between ASPECTS and mRS. Pearson chi-square test was used to identify the relationship between patient characteristics and their outcomes at bivariate analysis. Utility of the study; The ASPECTS on the non-contrast head CT scan is a predictor for functional outcomes in ischemic stroke as well as identifying patients eligible for thrombolysis and thrombectomy. Utilizing it in our Ugandan setting will facilitate timely diagnosis and identification of patients eligible for thrombolysis and thrombectomy. It will inform policy guidelines for immediate rehabilitation services at national level. Results; 120 patients were enrolled into the study and 118 analyzed for follow up for the functional outcomes. The median age was 60 with 57% being female. The average ASPECTS score was 5.71, SD ± 3.4 with the left hemisphere predominantly affected n=70. There was a significantly high inverse correlation between ASPECTS and mRS scores (r = -0.618, P< 0.001). 31% of patients received rehabilitation services. Poor outcomes among patients were associated with overall lower ASPECTS, no education, low GCS having MCA regions involved as M3, M5 and additional vascular territory PCA involved. Conclusion: The average ASPECTS from this study was 5.7; over half of the patients n꞊68 (56.8%) had the cut off ASPECTS for thrombectomy and thrombolysis of ≥ 6. The correlation of the ASPECTS and the mRS was -0.618, an inverse correlation as seen with other studies; therefore ASPECTS is a reliable tool to predict the functional outcomes. The majority of patients (83.1%) had poor outcomes. With a 26% mortality, reflects the need to utilize the ASPECTS to ensure appropriate timely interventions and rehabilitation. There is need for individualized stroke protocols in our hospitals to initiate thrombolysis and thrombectomy for these ischemic stroke patients.