Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study

J Rhein; G Charbonnier; M Nacher; M Gaudron; T Moulin; D R Rochemont; J-P Cottier; C Montagnac; N Sabbah; B de Toffol; BECATOUR Study Group

doi:10.1016/j.neurol.2023.02.068

Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study

Rev Neurol (Paris). 2023 Nov;179(9):975-982. doi: 10.1016/j.neurol.2023.02.068. Epub 2023 Jul 22.

Authors

J Rhein¹, G Charbonnier², M Nacher¹, M Gaudron³, T Moulin², D R Rochemont¹, J-P Cottier⁴, C Montagnac¹, N Sabbah⁵, B de Toffol⁶; BECATOUR Study Group

Affiliations

¹ Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana.
² Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France.
³ Neurology Department, CHU Bretonneau, 37044 Tours cedex, France.
⁴ Neuroradiology Department, CHU Bretonneau, 37044 Tours cedex, France.
⁵ Endocrinology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
⁶ Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana. Electronic address: bertrand.detoffol@ch-cayenne.fr.

PMID: 37487805
DOI: 10.1016/j.neurol.2023.02.068

Abstract

Background: Stroke is a major public health issue. Its epidemiology is still poorly known in French Guiana.

Method: We conducted a prospective observational study including 100 consecutive patients hospitalized for stroke in Cayenne (in French Guiana), and Tours and Besançon (in metropolitan France). We compared their age, medical history, cardiovascular risk factors, pre-admission Rankin score, Glasgow and NIHSS scores, usual treatments, acute phase management, type of stroke, duration of hospitalization, mechanism of stroke according to TOAST classification, NIHSS and Rankin scores at discharge, discharge treatments, and mode of discharge.

Results: In French Guiana, the average age of patients was 7years lower (62 y), patients were more frequently affected by hypertension (75%) and diabetes (31%). Lacunar strokes were overrepresented (16.1%), and infarctions of cardioembolic origin were underrepresented (12%). NIHSS entry and Glasgow scores were similar between French Guiana and mainland France. Acute management was different: thrombolysis rate (9.3%) was 3 to 4 times lower, thrombectomy was not available. Fewer patients were transferred to rehabilitation centers and more patients were transferred to home hospitalization.

Discussion: In Tours and Besançon, patients eligible for thrombectomy were overrepresented. This bias explains the overrepresentation of more severe infarctions and probably the overrepresentation of strokes of cardioembolic origin. Infarctions of undetermined origin were more numerous in French Guiana because patients were often discharged from hospital with an incomplete cardiological workup.

Conclusion: Despite some caveats, the profile of patients admitted for stroke in French Guiana is different from mainland France. The establishment of a stroke unit and an information campaign on the symptoms of stroke would allow better management.

Keywords: Ischemic stroke prospective study; Stroke management.

Publication types

Observational Study

MeSH terms

Child
Hospitalization
Humans
Infarction
Prospective Studies
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / etiology
Thrombectomy / adverse effects
Treatment Outcome