# Epidemiological Study of Stroke Presenting to the Emergency Department of a Tertiary Hospital: An Observational Study

## TL;DR

This study examines stroke cases in Nepal's emergency department, finding most are ischemic and treatment is often delayed.

## Contribution

The study provides new epidemiological data on stroke presentations in a high-volume emergency department in Nepal.

## Key findings

- Ischemic stroke was the most common type, affecting 76.34% of patients.
- Only 1.87% of patients received thrombolysis, indicating limited acute treatment use.
- Most patients (86.10%) were admitted to the general ward, not the ICU.

## Abstract

Stroke remains a major global health burden, ranking as the second leading cause of death and third leading cause of disability worldwide. Low- and middle-income countries, including Nepal, face a disproportionate share of this burden, characterized by delayed treatment and limited healthcare infrastructure. This study aimed to determine the epidemiological profile of stroke cases presenting to the emergency department of a tertiary hospital in Nepal.

A cross-sectional study was conducted using medical records of stroke patients presenting to the Emergency Department from August 2022 to September 2023. Data on demographics, stroke type, clinical outcomes, and management were collected and analyzed descriptively using STATA version 17.

Of 39,702 emergency department visits, 1,174 (2.96%) were stroke cases. Ischemic stroke occurred in 896 (76.34%) patients, hemorrhagic stroke in 175 (14.89%), and transient ischemic attack in 103 (8.82%). The mean age was 61.79 ± 15.76 years, and 704 (60.00%) patients were male. Admission to the general ward occurred in 1,011 (86.10%) patients, and 43 (3.65%) patients were admitted to the ICU. Thrombolysis was administered to 22 (1.87%) patients, and 11 (0.93%) were referred for thrombectomy. A total of 151 (12.90%) patients arrived within 4.5 hours of symptom onset.

The study highlights the predominance of ischemic stroke, delayed hospital presentations, and limited use of thrombolysis among stroke patients in a high-volume ED in Nepal.