Urgent stroke care in hospitals with a stroke unit. Quick Project
Por:
Masjuan, J, Alvarez-Sabin, J, Arias-Rivas, S, Blanco, M, de Felipe, A, Escudero-Martinez, I, Fuentes, B, Gallego-Cullere, J, Moniche-Alvarez, F, Munoz, L, de la Ossa-Herrero, NP, Sahuquillo, P, Santamarina, E, Sanz, B, Tembl, JI and Zandio, B
Publicada:
1 abr 2016
Resumen:
Introduction. A stroke is a time-dependent medical emergency. Swiftness in its recognition and in the care received by the patients plays a key role in the prognosis.
Aims. To analyse the medical intervention times, to evaluate possible areas where improvements can be made and to examine the allocation of resources in the centres.
Patients and methods. The study was based on a prospective register of patients with suspected stroke and stroke code activation treated in eight experienced Spanish stroke units. Onset-to-door, door-to-computed tomography (CT), door-to-needle, CT-to-needle and onset-to-needle times were collected. Information about the means of transport used to get to the hospital, the type of stroke and reperfusion therapies was also collected. With regard to the structural resources of the centres, data were gathered about the nurse-to-patient ratio, bed monitoring, availability of multimodal CT and magnetic resonance, and doing information or training courses.
Results. Altogether 197 patients were included, of whom 181 (151 infarctions and 30 brain haemorrhages) were valid. The medians (p25-p75) in minutes were: onset-to-door, 104 (70-188); door-to-CT, 27 (19-41); CT-to-needle, 30 (21-43); door-to-needle, 64 (49-83); and onset-to-needle, 156 (129-202). Reperfusion therapies were applied in 68 patients (45% of the cerebral infarctions), of which 81% were intravenous thrombolyses; 7%, endovascular treatments; and 12%, a combination of the two. The resources available in the centres were in accordance with those recommended by the clinical guidelines. There was a low percentage of patients who were studied by means of magnetic resonance.
Conclusion. The percentage of patients treated with thrombolysis was very high and although the times of the in-hospital circuits were good, there is still room for further improvement.
Filiaciones:
Masjuan, J:
Hosp Univ Ramon & Cajal, Serv Neurol, Ctra Colmenar Km 9,1, E-28034 Madrid, Spain
Univ Alcala, Inst Invest Ramon & Cajal, Madrid, Spain
Alvarez-Sabin, J:
Univ Autonoma Barcelona, Serv Neurol, Hosp Univ Vall dHebron, E-08193 Barcelona, Spain
Arias-Rivas, S:
Hosp Univ Santiago, Serv Neurol, Santiago De Compostela, A Coruna, Spain
Blanco, M:
Hosp Univ Santiago, Serv Neurol, Santiago De Compostela, A Coruna, Spain
de Felipe, A:
Hosp Univ Ramon & Cajal, Serv Neurol, Ctra Colmenar Km 9,1, E-28034 Madrid, Spain
Univ Alcala, Inst Invest Ramon & Cajal, Madrid, Spain
Escudero-Martinez, I:
Hosp Univ Virgen del Rocio, Serv Neurol, Seville, Spain
Fuentes, B:
Hosp Univ La Paz, Serv Neurol, Madrid, Spain
Gallego-Cullere, J:
Complejo Univ Navarra, Serv Neurol, Pamplona, Spain
Moniche-Alvarez, F:
Hosp Univ Virgen del Rocio, Serv Neurol, Seville, Spain
:
Hosp Badalona Germans Trias & Pujol, Serv Neurol, Badalona, Spain
:
Hosp Badalona Germans Trias & Pujol, Serv Neurol, Badalona, Spain
Sahuquillo, P:
Hosp Univ & Politecn La Fe, Serv Neurol, Valencia, Spain
Santamarina, E:
Univ Autonoma Barcelona, Serv Neurol, Hosp Univ Vall dHebron, E-08193 Barcelona, Spain
Sanz, B:
Hosp Univ La Paz, Serv Neurol, Madrid, Spain
Tembl, JI:
Hosp Univ & Politecn La Fe, Serv Neurol, Valencia, Spain
Zandio, B:
Complejo Univ Navarra, Serv Neurol, Pamplona, Spain
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