18 The in-hospital mortality rate for this group was 21.2%, which was higher than

the 3.4% to 11.2% 30-day case fatality rate in Norwegian19 and Italian20 patients with selleck inhibitor young-adult stroke. This suggests that stroke afflicts a large number of patients in their reproductive years in Iran, with higher-than-expected mortality. Thirdly, multiple logistic Inhibitors,research,lifescience,medical regression revealed significant higher in-hospital mortality in women and children but not in patients with low socioeconomic status or from rural areas. Similar to prior reports, we observed a slight male predominence in our sample; however, the mortality was higher in women compared to men. The high incidence of stroke mortality in women is probably due to longer life expectancy.21 Poor prognosis of stroke in the pediatric age group can be explained by devastating underlying general causes which make the final outcome poor.22 The last observation is the disturbing trend of a higher mortality rate over the study period (between 2001 Inhibitors,research,lifescience,medical and 2010). This stands in contrast to the recent

trends reported from developed and a few developing countries.23 The exact explanations Inhibitors,research,lifescience,medical are yet to be determined; nevertheless, contributing factors similar to those highlighted above may have played a role in this trend. Some shortcomings in this study are worth mentioning. First, this study is a retrospective single-hospital experience Inhibitors,research,lifescience,medical and might as such not be reflective of national Iranian standards. Second, the relatively high in-hospital mortality rate should be interpreted with caution because patients with a worse prognosis may have been over-represented among the patients who were admitted to our tertiary referral

center. Third, our cohort was identified based on the ICD-9 and ICD-10 coding systems; thus, coding error could not be eliminated. Fourth, stroke-specific characteristics such as stroke location, stroke severity Inhibitors,research,lifescience,medical scale, and 30-day mortality were not reported. Fifth, the specific causes of death were not determined according to the hospital database characteristics. Conclusion Our study reconfirmed that stroke is a crucial health problem in Iran. In comparison to western countries, a larger proportion of Iranian patients were Unoprostone young adults and the mortality rate was higher. Although Iran is considered a middle-income country, the allocation of resources to improve the health system may need to be revisited. There is an urgent need for Iranian hospitals to develop better measures to manage acute stroke patients. In a wider context, international organizations should propose guidelines to implement a specialized infrastructure for stroke care in developing countries; these guidelines may influence global outcomes associated with stroke. Acknowledgment This research was supported by the Health Policy Research Center at Shiraz University of Medical Sciences. We thank Mrs. Arjmand for her assistance with data collection, Dr.