Original article
Incidence and Profile of Inpatient Stroke-Induced Aphasia in Ontario, Canada

https://doi.org/10.1016/j.apmr.2009.09.020Get rights and content

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.

Section snippets

Study Population and Data Collection

The RCSN was established in 2001 to enable the measurement and monitoring of stroke care delivery and outcomes for Canadian patients at participating institutions. Currently, RCSN data include records from more than 30,000 adult stroke patients seen at 12 hospitals designated as regional stroke centers in the province of Ontario. Data are collected from prehospital stroke onset to discharge from acute care after a stroke. Facilities that are designated as regional stroke centers are required to

Incidence of Aphasia

A total of 3207 patients with a primary diagnosis of stroke were included in the 2004 to 2005 Ontario Stroke Audit. Of these, 965 (30%) had aphasia on admission, while 1131 (35%) had aphasia at the time of discharge (after an average length of stay of 15d). Using the number of patients with aphasia present at discharge and weighting the Ontario Stroke Audit data to reflect the general adult population in Ontario27 resulted in an overall incidence rate of .06%, or 60 per 100,000 persons per year

Discussion

This large Canadian study indicated that approximately 35% of stroke patients have aphasia at the time of discharge. This finding supports current literature that reports approximately one quarter to one third of patients with stroke experience aphasia.1, 11, 13, 14 Adjusted to the European standard population, the incidence rate reported for ages 20 years and older (48 per 100,000) is more than double the standardized incidence rate of 21 per 100,000 persons reported in the most recent

Conclusions

In summary, we found that the profile and patterns of service use 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 numbers of patients who acquire aphasia, the complexity of this communication disorder, and its impact on those who acquire it, there is a need to develop more rigorous standards regarding the assessment and collection of data related to

Acknowledgments

We thank J. Charles Victor, MSc, for his epidemiologic expertise and advice throughout the preparation of this article; Jeffrey Hoch, PhD, and Michelle Christian for their ideas concerning the focus and format of this article; and Ada Mok for administrative assistance. We also acknowledge the participation of the regional stroke centers in Ontario (see appendix 1 for full list of participating facilities).

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    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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