The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project.

In a prospective, community-based study of 675 consecutive patients with a first-ever stroke, of whom over 90% had computed tomography (CT) and/or necropsy examinations, 129 deaths occurred within 30 days of the onset of symptoms, a case fatality rate (CFR) of 19%. The 30 day CFR for patients with cerebral infarction was 10% (57 of 545, for primary intracerebral haemorrhage 52% (34 of 66), for subarachnoid haemorrhage 45% (15 of 33) and for those of uncertain pathological type 74% (23 of 31). The CFR for patients who had been functionally dependent pre-stroke was 33% compared with 17% for those who had been independent pre-stroke. The age-adjusted relative risk of death for patients who had been functionally dependent pre-stroke was not significantly greater (1.8, 95% confidence interval 0 to 4.3). There was a significant trend for CFR to increase with age (Chi square for trend = 4.0, p less than 0.05). This relationship was found in those patients who had been functionally independent prestroke (Chi square for trend = 7.9, p less than 0.005) but not in those who had been dependent pre-stroke (Chi square for trend = 0.5, NS). The pattern of increasing CFR with increasing age amongst those who had been independent prestroke was seen particularly in patients with cerebral infarction (Chi square for trend = 8.6, p less than 0.005). The age-adjusted relative risk of death for patients with cerebral infarction who had been functionally dependent pre-stroke was 2.2 (95% confidence interval 1.2 to 4.1). Fifty three percent of all deaths within 30 days of stroke were due to the direct neurological sequelae of the stroke. Patients with primary intracerebral or subarachnoid haemorrhages were significantly more likely to die in this way than those with cerebral infarction (relative risk 4.1; 95% confidence interval 3.4-4.9) and 56% of such deaths occurred within 72 hours of onset. In patients with cerebral infarction, 51% of deaths were due to complications of immobility (for example, pneumonia, pulmonary embolism) and these were more likely to occur after the first week. These findings have implications for clinical practice and the planning of clinical trials.

[1]  P. Sandercock,et al.  A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project--1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[2]  L. Kuller.  Incidence rates of stroke in the eighties: the end of the decline in stroke? , 1989, Stroke.

[3]  W M O'Fallon,et al.  Has there been a decline in subarachnoid hemorrhage mortality? , 1989, Stroke.

[4]  S J Phillips,et al.  Incidence rates of stroke in the eighties: the end of the decline in stroke? , 1989, Stroke.

[5]  J Bamford,et al.  A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-86. 1. Methodology, demography and incident cases of first-ever stroke. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[6]  Juliea Morris,et al.  Statistics in Medicine: Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates , 1988, British medical journal.

[7]  H. Schouten,et al.  Interobserver agreement for the assessment of handicap in stroke patients. , 1988, Stroke.

[8]  Juliea Morris,et al.  Calculating confidence intervals forrelative risks (oddsratios) andstandardised ratios andrates , 1988 .

[9]  R. Bloch,et al.  Interobserver agreement for the assessment of handicap in stroke patients. , 1988, Stroke.

[10]  B. Winblad,et al.  Autopsy-verified causes of death after stroke. , 2009, Acta medica Scandinavica.

[11]  P. Sandercock,et al.  Why are patients with acute stroke admitted to hospital? , 1986 .

[12]  P. Sandercock,et al.  IS A CONTROLLED TRIAL OF LONG-TERM ORAL ANTICOAGULANTS IN PATIENTS WITH STROKE AND NON-RHEUMATIC ATRIAL FIBRILLATION WORTHWHILE? , 1986, The Lancet.

[13]  S. McCarthy,et al.  Low-dose subcutaneous heparin in the prevention of deep-vein thrombosis and pulmonary emboli following acute stroke. , 1986, Age and ageing.

[14]  J. Hughes.  Necropsies on patients after stroke. , 1985, British medical journal.

[15]  R. Beaglehole,et al.  Event, incidence and case fatality rates of cerebrovascular disease in Auckland, New Zealand. , 1984, American journal of epidemiology.

[16]  P. Wolf,et al.  Subarachnoid and intracerebral hemorrhage , 1984, Neurology.

[17]  V. Hachinski,et al.  Early Mortality Following Stroke: A Prospective Review , 1984, Stroke.

[18]  W. Garraway,et al.  The changing pattern of survival following Stroke. , 1983, Stroke.

[19]  P. Wolf,et al.  Accuracy of death certification of stroke: the Framingham Study. , 1982, Stroke.

[20]  B. Schulte,et al.  Epidemiology of stroke in Tilburg, the Netherlands. The population‐based stroke incidence register: 2. Incidence, initial clinical picture and medical care, and three‐week case fatality. , 1982, Stroke.

[21]  B. Schulte,et al.  An evaluation of risk factors for stroke in a Dutch community. , 1982, Stroke.

[22]  D. Wiebers,et al.  Mechanisms and Timing of Deaths from Cerebral Infarction , 1981, Stroke.

[23]  E. Mcgoogan,et al.  A prospective study of 1152 hospital autopsies: II. Analysis of inaccuracies in clinical diagnoses and their significance , 1981, The Journal of pathology.

[24]  H. M. Cameron,et al.  A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification , 1981, The Journal of pathology.

[25]  M. Enjoji,et al.  Decreasing Trend in Incidence And Mortality from Stroke In Hisayama Residents, Japan , 1981, Stroke.

[26]  M. Huckman,et al.  Time course of cerebral swelling in stroke: a correlative autopsy and CT study. , 1980, Advances in neurology.

[27]  K. Aho,et al.  Cerebrovascular disease in the community: results of a WHO collaborative study. , 1980, Bulletin of the World Health Organization.

[28]  L. Elveback,et al.  The decreasing incidence of primary intracerebral hemorrhage: A population study , 1979, Annals of neurology.

[29]  L. Phillips,et al.  Sudden Death from Stroke , 1977, Stroke.

[30]  W. E. Drake,et al.  Acute Stroke Management and Patient Outcome: The Value of Neurovascular Care Units (NCU) , 1973, Stroke.

[31]  M. Brown,et al.  Mortality factors in patients with acute stroke. , 1973, JAMA.

[32]  N. Nie,et al.  Statistical Package for the Social Sciences , 1970 .

[33]  Parrish Hm,et al.  Mid-Missouri stroke survey: a preliminary report. , 1966 .

[34]  H. Parrish,et al.  Mid-Missouri stroke survey: a preliminary report. , 1966, Missouri medicine.

[35]  R. G. Berry,et al.  Swelling of the brain following ischemic infarction with arterial occlusion. , 1959, Archives of neurology.

[36]  J. Rankin.  Cerebral Vascular Accidents in Patients over the Age of 60: II. Prognosis , 1957, Scottish medical journal.