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Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services

Al Hashmi AM 1 , Shuaib A 2 , Imam Y 3 , Amr D 4 , Humaidan H 5 , Al Nidawi F 6 Show all authors , Sarhan A 7 , Mustafa W 8 , Khalefa W 9 , Ramadan I 10 , Usman FS 11 , Hokmabadi ES 12 , Ghorbani M 13 , Nassir T 14 , Aladham F 15 , Salmeen A 16 , Kikano R 17 , Muda S 18 , Jose S 19 , Bulushi MA 20 , Sajwani B 21 , Wasay M 22 , Bashir Q 23 , Al Hazzani A 24 , Khoja W 25 , Alkadere R 26 , Osman H 27 , Hussein A 28 , Churojana A 29 , Hammami N 30 , Ozdemir AO 31 , Giray S 32 , Gurkas E 33 , Hussain SI 34 , Sallam AR 35 , Mansour OY 36

Affiliations 

  • 1 Central Stroke Unit, Neuroscience Directorate, Khoula Hospital, MOH, Muscat, Oman
  • 2 Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
  • 3 Neuroscience Institute, Hamad General Hospital, Doha, Qatar
  • 4 Stroke and Neurointervention Unit, Alexandria University School of Medicine, Alexandria, Egypt
  • 5 Stroke Unit, Salmaniya Medical Complex, Al Manamah, Bahrain
  • 6 King Hamad Hospital, Al Muharaq, Bahrain
  • 7 Al-Hussein University Hospital, Cairo, Egypt
  • 8 Department of Neurology, Mansoura University Hospital, Mansoura, Egypt
  • 9 Department of Neurology, Maady Military Hospital, Cairo, Egypt
  • 10 Department of Neurology, Semoha Emergency Hospital, Alexandria University, Alexandria, Egypt
  • 11 Stroke Unit, Pelni General Hospital, Jakarta, Indonesia
  • 12 Neuroscience Research Center, Tabriz University of Medical Science, Tabriz, Iran
  • 13 Division of Vascular and Endovascular Neurosurgery Firoozgar Hospital, Tehran, Iran
  • 14 Department of Internal Medicine, Maysan Cardiac Center, MOH, Musan, Iraq
  • 15 Specialty Hospital, Amman, Jordan
  • 16 Department of Neurology, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
  • 17 Lebanese American University, Head of Interventional Radiology, Beirut, Lebanon
  • 18 Department of Radiology, Pengajar Hospital UPM, FPSK, Universiti Putra Malaysia, Serdang, Malaysia
  • 19 Statistical Specialist, Oman Medical Specialty Board (OMSB), Muscat, Oman
  • 20 Stroke Unit, Sultan Qaboos Hospital, MOH of Oman, Salalah, Oman
  • 21 Stroke Unit, Sohar Hospital, MOH of Oman, Sohar, Oman
  • 22 Department of Neurology, Aga Khan University, Karachi, Pakistan
  • 23 Department of Neurology, Services Institute of Medical Sciences, Lahore, Pakistan
  • 24 Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  • 25 Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  • 26 Family Care Hospital, Riyadh, Saudi Arabia
  • 27 Department of Neurology, National Ribat University, Khartoum, Sudan
  • 28 Department of Neurology, El Shaab Teaching Hospital, Khartoum, Sudan
  • 29 Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 30 National Institute Mongi Ben Hamida of Neurology, Tunis, Tunisia
  • 31 Interventional Neurology and Neurocritical Care Program, Eskisehir Osmangazi University,, Eskişehir, Turkey
  • 32 Gaziantep University Medical Faculty, Gaziantep, Turkey
  • 33 Stroke Center, Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
  • 34 Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
  • 35 Department of Neurology, University Hospital of Sana'a, Sanan, Yemen
  • 36 Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Front Neurol, 2022;13:1016376.
PMID: 36408502 DOI: 10.3389/fneur.2022.1016376

Abstract

Background: Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa.

Objective: Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke.

Method: Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022.

Results: The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250-1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15-75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH.

Conclusion: This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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