The last days of dying stroke patients referred to a palliative care consult team in an acute hospital

Eur J Neurol. 2010 Jan;17(1):73-7. doi: 10.1111/j.1468-1331.2009.02744.x. Epub 2009 Jul 14.


Background and purpose: Needs of patients dying from stroke are poorly investigated. We aim to assess symptoms of these patients referred to a palliative care consult team, and to review their treatment strategies.

Methods: All charts of patients dying from stroke in a tertiary hospital, and referred consecutively to a palliative care consultant team from 2000 to 2005, were reviewed retrospectively. Symptoms, ability to communicate, treatments, circumstances and causes of death were collected.

Results: Forty-two patients were identified. Median NIH Stroke Scale on admission was 21. The most prevalent symptoms were dyspnoea (81%), and pain (69%). Difficulties or inability to communicate because of aphasia or altered level of consciousness were present in 93% of patients. Pharmacological respiratory treatments consisted of anti-muscarinic drugs (52%), and opioids (33%). Pain was mainly treated by opioids (69%). During the last 48 h of life, 81% of patients were free of pain and 48% of respiratory distress. The main causes of death were neurological complications in 38% of patients, multiple medical complications in 36%, and specific medical causes in 26%.

Conclusions: Patients dying from stroke and referred to a palliative care consult team have multiple symptoms, mainly dyspnoea and pain. Studies are warranted to develop specific symptoms assessment tools in non-verbal stroke patients, to accurately assess patients' needs, and to measure effectiveness of palliative treatments.

MeSH terms

  • Acute Disease / mortality
  • Acute Disease / therapy
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use
  • Aphasia / epidemiology
  • Attitude to Death
  • Cause of Death / trends
  • Child
  • Comorbidity
  • Consciousness Disorders / epidemiology
  • Disability Evaluation
  • Dyspnea / epidemiology
  • Dyspnea / therapy
  • Hospitals / statistics & numerical data*
  • Hospitals / trends
  • Humans
  • Infant
  • Muscarinic Antagonists / therapeutic use
  • Needs Assessment
  • Outcome Assessment, Health Care / methods
  • Pain / epidemiology
  • Pain Management
  • Pain Measurement
  • Palliative Care / methods*
  • Palliative Care / statistics & numerical data
  • Patient Care Planning
  • Quality of Health Care / statistics & numerical data
  • Quality of Health Care / trends
  • Retrospective Studies
  • Severity of Illness Index
  • Stroke / mortality*
  • Stroke / physiopathology
  • Stroke / therapy*
  • Terminal Care
  • Treatment Outcome


  • Analgesics, Opioid
  • Muscarinic Antagonists