1. Curaçao Stroke Questionnaire Izzy Gerstenbluth Norédiz Lourents November 12, 2010

2. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Curaçao: Area & density  Area: 444 km²  Population Density per km²: 319

3. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Curaçao: population  Population: circa 145.000 0-19 39.000 20-59 81.000 60+ 25.000 (17.4%)  Live births: ± 2000/ yr  Deaths: ± 1000 -1200/yr  Life expectancy at Birth: ♀ 80.1 ♂ 72.4

4. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Intramural care facilities  Hospitals: St. Elisabeth (± 350 beds) Adventist Hospital (± 75 beds) Taams Kliniek (± 75 beds) Capriles Kliniek – psychiatric hospital  nursing home: Bethesda (± 160 beds)  Geriatric homes (± 750 beds)  Rehabilitation Clinic (Verriet Institute)

5. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Objectives  Measure BOD for common RF  Planning (Stroke Unit)  Quality of care (Interventions/protocols/ collaboration between health care providers)  Needs assessment  Trends over time  Research issues

6. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Set-up  STEP-1  STEP-2 ?  Hospital/clinician based (Specialists & Residents)  Coordination & data management: ERU  Admittance/imprint/pickup 2-3/wk  Questionnaire in list  Filled out upon discharge/ p-u 2-3/wk  Check & review :missing data?  Feed back meetings (1/month)

7. CSQ 12 Nov, 2010; Gerstenbluth/Lourents CSQ: May 1st- Nov 11th, 2010  133 strokes reported (73 males and 60 females)  123 were discharged and have filled out Questionnaires; including 21 deceased  Questionnaires of 10 patients (5 males and 5 females) are still pending in different wards of the Sint Elisabeth Hospital  Of the admitted patients 79% were admitted the same day or the day after the stroke; 8% were admitted 2 days after the stroke and 6.4% were admitted more than 3 days after the stroke. 3.4% had a stroke while in hospital.

8. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Number of strokes reported 1 May –11 Nov. 2010 (n=123)

9. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Age distribution and gender for strokes recorded in May-Nov. 2010* (n=123) * May 1, 2010 – Nov 11, 2010; 21 persons died of which 6 were female and 15 were male

10. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Deceased patients by sex and age

11. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Type and subtypes of stroke  Ischemic stroke:92* Cardio-embolism(21) large artery atherosclerosis(19) Small vessel occlusion(53) Other subtype(0)  Intracerebral hemorrhage23  Subarachnoid hemorrhage8  Unspecified type1  Three (3) patients had also mention of subdural hematoma  *1 person had both cardio-embolism and a small vessel occlusion

12. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Vital status and type of stroke (n=123) Type of strokeAliveDeceased* Ischemic stroke7913 Intracerebral hemorrhage194 Subarachnoid hemorrhage53 One (1) patient died without mention of type of stroke but with mention of subdural hematoma

13. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Previous stroke

14. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Destination at discharge

15. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Riskfactors

16. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Medication in hospital and at discharge In hospital medication Anticoagulant drugs 36 Antiplatelet drugs 70 Thrombolysis 1 Othermedication 48 Medication at discharge Anticoagulant drugs26 Antiplatelet drugs52 Antidiabetic drugs28 Cholesterol lowering drugs60 Antihypertensives79 Other medication 17

17. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Modified Rankin scale pre stroke and at discharge Modified Rankin scalePre stroke At Discharge* No symptoms at all 6914 No significant disability 1821 Slight disability 138 Moderate disability, able to walk 1215 Moderate disability unable to walk 722 Severe disability 221 unknown 21 *21 patients died

18. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Modified Rankin scores pre-stroke vs. Modified Rankin scores at discharge

19. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Percentage of deaths due to stroke

20. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Stroke Mortality YearPosition ♂Position ♀Total 1988121 1989222 1990211 1991211 1992211 1993111 1994222 1995222 1996122 1997322 1998222 1999323 2000122

21. CSQ 12 Nov, 2010; Gerstenbluth/Lourents CSQ-data entry format in MS-Access

22. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Questionnaire  Obesity? WC  SES data: problematic  1 st stroke in “study period” & subsequent stroke  Neuro signs present: broadened: problematic?  Subtypes…subdural hematoma…??  TOAST  MRA?  Timing scanning left out?  Vascular RF : cardioembolism/ alcohol??  Discharge questions: sI 16 deleted

23. CSQ 12 Nov, 2010; Gerstenbluth/Lourents Not (yet ) included:  28 day follow-up (PH nurse?)  Fatal stroke events in community (Step 2)  Non fatal stroke events in community (Step 3: Reporting from: Geriatric/nursing homes GP’s District nursing ?)