¿Las unidades de tratamiento de apoplejía salvan vidas?
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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
P Langhorne1, B O Williams, W Gilchrist
1Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow, UK.
Lancet (London, England)
|August 14, 1993
Resumen
Las unidades especializadas en accidente cerebrovascular mejoran la recuperación del paciente y reducen significativamente las tasas de mortalidad. Este metanálisis de ensayos controlados aleatorizados confirma que la atención en la unidad de accidente cerebrovascular reduce los riesgos de muerte en un 28% en 4 meses y persiste a largo plazo.
Área de la Ciencia:
- Neurología Neurología.
- Salud Pública La salud pública.
- La medicina basada en la evidencia.
Sus antecedentes:
- Se sabe que la atención de la unidad de accidente cerebrovascular acelera la recuperación del paciente.
- Sin embargo, su impacto en las tasas de mortalidad ha sido objeto de debate.
- Investigaciones anteriores no sugirieron una influencia significativa en la mortalidad.
Objetivo del estudio:
- Para analizar estadísticamente los ensayos controlados aleatorios que comparan la atención de la unidad de accidente cerebrovascular con la administración general de la sala.
- Para determinar el efecto de las unidades especializadas en accidentes cerebrovasculares en la mortalidad de los pacientes.
- Evaluar el impacto a largo plazo de la atención de la unidad de accidente cerebrovascular en las tasas de supervivencia.
Principales métodos:
- Una visión general sistemática de los ensayos controlados aleatorios (ECA) publicados entre 1962 y 1993.
- La inclusión de 10 ECA con participación de 1586 pacientes con accidente cerebrovascular (766 en unidades de accidente cerebrovascular, 820 en salas generales).
- Análisis estadístico utilizando odds ratios para comparar la mortalidad dentro de los 4 y 12 meses posteriores al accidente cerebrovascular.
Principales resultados:
- Se observó una reducción estadísticamente significativa en la mortalidad dentro de los primeros 4 meses (OR 0,72, IC del 95% 0,56-0,92), lo que indica una disminución del 28%.
- Esta reducción de la mortalidad se mantuvo a los 12 meses (OR 0,79, IC del 95% 0,63-0,99).
- Los resultados se mantuvieron consistentes incluso cuando el análisis se limitó a ensayos con procedimientos formales de aleatorización.
Conclusiones:
- El manejo de pacientes con accidente cerebrovascular en unidades especializadas en accidente cerebrovascular se asocia con una reducción significativa y sostenida de la mortalidad.
- La atención de la unidad de accidente cerebrovascular ofrece un beneficio de supervivencia más allá de acelerar la recuperación.
- Estos hallazgos apoyan la implementación generalizada de unidades especializadas de atención de accidentes cerebrovasculares.
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