Impact of the implementation of a stroke unit on vital and functional prognosis of stroke patients in Libreville: a retrospective comparative cohort study

Abstract

Background: Stroke is a leading cause of morbidity and mortality in Gabon. Its management relies on a dedicated Stroke Unit (SU). The Libreville SU is one of the few in Sub-Saharan Africa and the second in Central Africa. Objective: To evaluate the impact of the implementation of the Stroke Unit (SU) on the functional and vital prognosis of stroke patients in Libreville, Gabon. Methods: This study compared stroke outcomes before (Jan 2019–Sept 2021) and after (Oct 2021–Dec 2023) the implementation of a Stroke Unit (SU). We included patients aged 18 and above with stroke confirmed on imaging who were treated in either conventional neurology (CN) or the SU. Primary outcomes were inpatient, 30-day, 3-month, and 1-year mortality and functional disability (binary modified Rankin Scale) at admission and discharge. Results: 740 patients were included (370 CN; 370 SU). The mean age was 57.7±12.9 years, and 52.8% were male. Median length of stay decreased from 10 days (CN) to 4 days (SU). Complications were significantly less frequent in the SU group, particularly urinary tract infections (p<0.001) and pneumonia (p<0.001). In-hospital mortality decreased from 6.2% (CN) to 0.8% (SU; p=0.002). Mortality at 3, 6, and 12 months showed no significant difference between groups. Factors associated with mortality included age 70–79 years (p=0.022), Glasgow Coma Score 9–12 (p=0.035), and pneumonia (p=0.003). Functional independence at discharge was higher in the SU group (41.6% vs. 38.4%, p<0.001). Conclusion: Implementation of a Stroke Unit significantly improved short-term survival and functional prognosis. Long-term mortality remained high, underscoring the need for strengthened post-stroke secondary prevention and rehabilitation programs.