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Table 1 Characteristics of studies on interventions for acute stroke care

From: Interventions for acute stroke management in Africa: a systematic review of the evidence

Lead author year and country Study aim Study design Intervention Level of evidence Duration Population sample Outcome measures Key results
Villiers et al. 2009
South Africa
Examine the impact of multidisciplinary stroke care on in-hospital mortality, resource utilisation and access to in-patient rehabilitation facilities for stroke patients admitted to the stroke unit Retrospective study Stroke unit Level 3 December 2001–February 2002
March 2002–May 2002
195 patients
Mean age = 58.8
60% were female
Length of hospital stay in-patient death transfer to a tertiary hospital number of patients who accessed CT brain In-hospital mortality was 31 (33%) in general ward compared to 16 (16%) in the stroke unit (p = 0.005)
Mean length of hospital stay before stroke unit was 5.1 (6.5, 3.8–6.4) days compared with 6.8 (4.5, 5.9–7.6) days after stroke unit care (p = 0.01)
Access to CT brain scans increased from 13% (12) to 16% (16)
Referrals to the tertiary academic hospital 7% (n = 7) vs. 4% (n = 4) did not change significantly
Wasserman and Bryer 2012
South Africa
To evaluate early outcomes and safety of stroke thrombolysis in a South African setting Prospective study Thrombolytic therapy Level 3 January 2000–February 2011 42 patients Early neurological recovery functional independence at discharge rate of symptomatic intracranial haemorrhage (SICH)
Death
Mean time to t-PA infusion was 160 min (SD 50; range 60–270). 72.5% patients were thrombolysed within 180 min
Median NIHSS score fell to 7.5 (IQR 1 to 15) by the time of discharge
67% of patients achieved significant neurological improvement after thrombolysis
40.5% were functionally independent
2 (4·8%) patients suffered SICH
3 (7·1%) patients died at discharge
Klemperer et al. 2014
South Africa
To evaluate the performance of SITS-SICH and SEDAN scores in predicting the risk of SICH after thrombolysis Retrospective Study Thrombolytic therapy Level 3 2000–2012 41 patients Bleeding complications
SICH risk
2 (4.9%) patients experienced SICH, (95% CI: 0–11.5%), SITS-SICH (5.1%) and SEDAN (6.5%) cohorts
23 patients accessed CT brain scan
Naima Chtaou et al. 2016
Morocco
To report the case series of all patients who were treated with rt-PA in a stroke unit of HASSAN II University hospital between 2010 and 2013 Case series Thrombolytic therapy Level 4 2010–2013 52 patients
mean age = 63 years
  17 patients (32.7%) were treated within a 3-h window of stroke onset and 35 (67.3%) within 3–4.5 h
25 patients (48%) had significant early improvements within 24 h, 21 (40.3%) had good outcomes at 3 months and 15 (29%) died
Mean door-to-needle time was 75 min and mean onset-to-treatment was 212 min
3 asymptomatic ICH and 4 symptomatic ICHs were reported
2 of the 4 symptomatic ICHs were fatal