Abstract
Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of
inpatient stroke-induced aphasia in Ontario, Canada.
Objectives
To determine the incidence rate of inpatient stroke-induced aphasia in Ontario, Canada,
and to examine the demographic and clinical characteristics for stroke patients with
and without aphasia.
Design
Age- and sex-specific incidence rates for aphasia in Ontario were calculated using
the Ontario Stroke Audit. In addition, data collected from the Registry of the Canadian
Stroke Network (RCSN) were used to determine the demographic and clinical characteristics
for stroke patients with and without aphasia.
Setting
All hospitals and regional stroke centers in Ontario, Canada.
Participants
The Ontario Stroke Audit is a representative weighted sample of more than 3000 stroke
inpatients admitted to emergency departments in all hospitals in Ontario within the
2004/2005 fiscal year. RCSN data included a cohort of more than 15,000 consecutive
patients presenting with stroke at 12 regional stroke centers in Ontario from 2003
to 2007.
Interventions
Not applicable.
Main Outcome Measures
Presence of aphasic symptoms on admission to hospital and at discharge, age and sex,
stroke type and severity, severity of disability, services received in hospital, length
of stay, and discharge destination.
Results
Thirty-five percent (1131/3207) of adult patients admitted with a diagnosis of stroke
in the province of Ontario during the 2004 to 2005 Ontario Stroke Audit had symptoms
of aphasia at the time of discharge. This amounts to an incidence rate of 60 per 100,000
persons per year. Risk of aphasia increased significantly with age. In comparison
with nonaphasic stroke patients, patients with aphasia were older, presented with
more severe strokes on admission, had more severe disability, and were more frequently
discharged to long-term care and/or rehabilitation (unadjusted results). Adjusting
for stroke severity, age, sex, comorbidity, and stroke subtype, the presence of aphasia
was found to be an independent predictor of longer hospital stays, increased use of
rehabilitation services, and higher rates of thrombolytic therapy.
Conclusions
A significant number of people with stroke experience aphasia, with advancing age
associated with a higher risk. The profile and patterns for stroke patients with aphasia
differed significantly from those who did not experience aphasia as a residual disability
after stroke, particularly in relation to service usage. Given the personal and system
cost associated with aphasia, best practices in the area of stroke should include
recommendations on how to best serve this population throughout the clinical pathway.
Key Words
List of Abbreviations:
CI (confidence interval), RCSN (Registry of the Canadian Stroke Network), TIA (transient ischemic attack)To read this article in full you will need to make a payment
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Article info
Footnotes
The Institute for Clinical Evaluative Sciences (ICES), which provided the data for this study, is supported by an operating grant from the Ontario Ministry of Health and Long-Term Care. The Registry of the Canadian Stroke Network (RCSN) was funded by a grant from the Canadian Stroke Network. The views expressed here do not necessarily reflect those of the Ministry.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
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Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
