ASSESSING SEVERITY OF ISCHEMIC STROKE AND ASSOCIATED FACTORS AT EMERGENCY DEPARTMENTS IN NABLUS, PALESTINE

Abstract

Abstract Background: ''Ischemic stroke'' is a major cause of death and disability worldwide, and its severity at presentation can influence clinical management and prognosis. ''The National Institutes of Health Stroke Scale (NIHSS)'' is widely used to quantify neurological impairment in patients with acute stroke. . Despite the importance of early assessment of stroke severity, limited evidence is available regarding factors associated with NIHSS-defined severity among patients presenting to emergency departments in Palestine. Objective: The study aimed to assess the severity of ischemic stroke and identify socio-demographic, clinical, and emergency department factors associated with NIHSS-defined stroke severity among patients presenting to emergency departments in Nablus, Palestine.

Methods: A quantitative analytical cross-sectional study was conducted among 61 patients with ischemic stroke presenting to emergency departments of selected hospital in Nablus, Palestine. Data were collected using a structured questionnaire and clinical assessment, including the NIHSS and "Glasgow Coma Scale (GCS)". Descriptive statistics were used to summarize participant characteristics and NIHSS scores. Mann–Whitney U, Regression and Kruskal–Wallis tests were used to examine bi-variate associations, while multiple linear regression was conducted to identify factors independently associated with NIHSS scores. Results: NIHSS scores ranged between 1 and 27 with an average of 9.89 ± 7.57. Among the study population, 32.8%, 42.6%, 8.2% and 16.4% suffered from minor, moderate, moderately severe and severe stroke respectively. NIHSS scores varied significantly based on several factors, both demographic, clinical and emergency room based. On multivariate regression analysis, TIA history, time to first evaluation from ED arrival and GCS score were significant predictors of NIHSS, while dyslipidemia showed marginal significance. Conclusion: This study showed that ischemic stroke severity NIHSS among patients presenting to emergency departments in Nablus mostly moderate with several clinical factors being related to higher NIHSS scores; Diabetes, atrial fibrillation chronic kidney disease, dyslipidemia, previous TIA or stroke and pre-stroke functional status were associated with greater severity. However, when the different factors we considered together, previous TIA, GCS previous at presentation and especially the time taken to perform the initial assessment were the main factors related to stroke severity. These findings highlight the importance of recognizing stroke early and assessing patients promptly and systematically in the emergency departments. Finally, further multicenter studies with large samples are recommended to confirm these findings and provide stronger evidence for stroke care