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[Descriptive analysis of patients admitted to hospital for acute cerebrovascular disease]
F J Barrero1, M J Gómez, J Gutiérrez
1Servicio de Neurología; Hospital Clínico Universitario "San Cecilio", Granada, 18012, España.
Insights
This study analyzed acute cerebrovascular disease (ACVA) patient data, revealing delays in emergency care and neurological attention. It highlights insufficient rehabilitation and medication use, leading to higher mortality post-discharge.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Context:
- Acute cerebrovascular disease (ACVA) represents a significant portion of hospital admissions for neurological conditions.
- Understanding local healthcare resource utilization for ACVA is crucial for effective management.
- This study addresses the need for specific data on ACVA in a particular setting.
Purpose:
- To analyze key variables associated with stroke admissions within a defined healthcare setting.
- To evaluate patient outcomes at 100 days and 6 months post-admission.
- To identify factors influencing resource use and patient prognosis in ACVA.
Summary:
- The study analyzed 107 ACVA cases, with a mean age of 70.54 years and an average admission of 13.53 days.
- Ischemic strokes constituted 87.5% of cases, with hypertension and diabetes as prevalent risk factors.
- Intrahospital mortality was 5.8%, with common findings including paralysis and speech disorders.
Impact:
- Identified significant delays in emergency department and neurological attention, potentially due to lack of specialized personnel.
- Highlighted suboptimal use of rehabilitation services and antiplatelet medications at discharge.
- Observed increased mortality rates after hospital discharge compared to in-hospital rates, emphasizing the need for improved post-acute care and follow-up.
Introduction:
Acute cerebrovascular disease (ACVA) makes up a high proportion of the neurological patients admitted to hospital, but we do not know the exact figures in our setting. We consider that it would be useful if the use of health-care resources for attending these patients was to be evaluated and studied by the neurologists who direct them.
Objective:
To analyze a predetermined series of variables related to strokes in our setting. Patients and methods. We made a descriptive analysis by means of a questionnaire, recording variables related to the admission to the neurology department of patients with probable ACVA, at 100 days and with further evaluation 6 months later.
Results:
We recorded 107 cases with ACVA confirmed in 101 of 104 patients with averages of: 70.54 years, average admission 13.53 days and intrahospital mortality 5.8%. The most common neurological findings were paralysis and speech disorder. The proportion of ischaemic stroke as compared with haemorrhagic stroke was 87.5% to 12.5%. The prevalence of usual risk factors was: arterial hypertension, diabetes and cardiopathy. The percentage of patients given rehabilitation treatment during their admission was 41.34%. A proportion, 37.2%, of the patients were referred to Hospital San Rafael for convalescence and treatment. The average time before evaluation by a neurologist was 30.23 hours. Eleven of 86 patients who answered a weekly questionnaire died (12.8%) and 54/86 had no rehabilitation treatment during the week (62.8%).
Conclusions:
We found no differences in the epidemiological characteristics as compared with other studies. The excessive lapse of time before attending the emergency department was striking, as was the delay in receiving neurological attention since there was no emergency neurologist available and fewer haemorrhagic strokes since there was no neurosurgical service available. There was little use of salicylates as a platelet anti-aggregrant agent on discharge from hospital, little rehabilitation treatment six months after the stroke, and twice as much mortality as when the patients were in hospital. We consider that a more detailed and extensive analysis would be fully justified in our setting, preferably with more people interested in the early and late treatment of ACVA taking part and prolonged follow-up of these patients.