Stroke (cerebrovascular accident)

OBJECTIVE
To analyze the association between time of arrival at a reference hospital and mortality of people with ischemic stroke.


METHOD
Descriptive and inferential statistics were used. Modifying and confounding variables between time of arrival and mortality were observed in the multivariate analysis. The Akaike Information Criterion was used to choose the model. Statistical significance of 5% and risk correction using the Poisson Model were adopted.


RESULTS
Most participants arrived within 4.5 hours of symptom onset or wake up stroke to the referral hospital and 19.4% died. The score of the National Institute of Health Stroke Scale was a modifier. In the multivariate model stratified by scale score ≥14, arrival time >4.5h was associated with lower mortality; and age ≥60 years and having Atrial Fibrillation, to higher mortality. In the model stratified by score ≤13, previous Rankin ≥3, and presence of atrial fibrillation were predictors of mortality.


CONCLUSION
The relationship between time of arrival and mortality up to 90 days was modified by the National Institute of Health Stroke Scale. Prior Rankin ≥3, atrial fibrillation, time to arrival ≤4.5h, and age ≥60 years contributed to higher mortality.

Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days.

OBJECTIVE
to understand the professional interaction in the Emergency Care Network in the care of patients with acute ischemic stroke in the city of Salvador/Bahia.


METHODS
the Grounded Theory methodological framework, Straussian strand, and the health networks theoretical framework were used. An in-depth interview was used, between October 2019 and October 2020, with 75 professionals from the Mobile Emergency Care Service, Emergency Care Units and reference hospital.


RESULTS
5 categories and 24 subcategories point to shared goals among professionals, but they show elements of fragmentation of connections between services, such as the absence of a single language and conduct, obstacles to professional relationships and lack of knowledge of the other's role.


CONCLUSIONS
to improve network relationships and care of patients with stroke, there is a need for well-established connecting elements, such as flows and protocols, supported by continuing education actions.

Network professional interaction in the care of patients with stroke.

RESUMO Objetivo: Analisar a associação entre tempo de chegada a hospital de referência e mortalidade de pessoas com Acidente Vascular Cerebral isquêmico. Método: Foram utilizadas estatísticas descritivas e inferenciais. Variáveis modificadoras e confundidoras entre tempo de chegada e mortalidade foram verificadas na análise multivariada. O Critério de Informação de Akaike foi utilizado para escolha do modelo. Adotou-se significância estatística de 5% e correção de risco pelo Modelo de Poisson. Resultados: A maioria dos participantes chegou em até 4,5 horas do início dos sintomas ou wake up stroke ao hospital de referência e 19,4% morreram. A pontuação da National Institute of Health Stroke Scale foi um modificador. No modelo multivariado estratificado por pontuação da escala ≥14, o tempo de chegada >4,5h estava associado a menor mortalidade; e idade ≥60 anos e ter Fibrilação Atrial, a maior mortalidade. No modelo estratificado por pontuação ≤13, Rankin prévio ≥3 e ter fibrilação atrial foram preditores de mortalidade. Conclusão: A relação entre tempo de chegada e mortalidade até 90 dias foi modificada pela pontuação da National Institute of Health Stroke Scale. Rankin prévio ≥3, fibrilação atrial, tempo de chegada ≤4,5h e idade ≥60 anos contribuíram para maior mortalidade.

/pdf/mortalidade-por-acidente-vascular-cerebral-isquemico-e-tempo-3a9uth6t.pdf

Mortalidade por acidente vascular cerebral isquêmico e tempo de chegada a hospital: análise dos primeiros 90 dias

RESUMO Objetivo: compreender a interação profissional na Rede de Atenção às Urgências e Emergências no atendimento ao paciente com acidente vascular cerebral isquêmico agudo na cidade de Salvador/Bahia. Métodos: foram utilizados o referencial metodológico da Teoria Fundamentada nos Dados, vertente straussiana, e o referencial teórico sobre redes em saúde. Foi empregada entrevista em profundidade, entre outubro de 2019 e outubro de 2020, com 75 profissionais do Serviço de Atendimento Móvel de Urgência, Unidades de Pronto Atendimento e hospital referência. Resultados: 5 categorias e 24 subcategorias apontam compartilhamento de objetivos entre profissionais, mas evidenciam elementos de fragmentação das conexões entre os serviços, como a ausência de linguagem e conduta única, entraves das relações profissionais e desconhecimento da função do outro. Conclusões: para aprimorar relações em rede e o atendimento ao paciente com acidente vascular cerebral, há necessidade de elementos conectores bem estabelecidos, como fluxos e protocolos, fundamentados por ações de educação permanente.

Interação profissional em rede no atendimento ao paciente com acidente vascular cerebral

Background: Cerebrovascular diseases (CVD) are a public health problem in Brazil. In Roraima, the problem may be even more serious, since there is no specific acute phase treatment capable of modifying the natural history of stoke. Objective: to evaluate the clinical and socioeconomic consequences of the stroke in Roraima, a Brazilian state in Amazonian region. Method: Observational, descriptive, quantitative cohort study. Fifty adult patients were included consecutively, when they were treated and diagnosed with stroke in the General Hospital of Roraima from 01/01/2016 to 06/30/2016. The patients were followed up during hospitalization and reassessed six months after the event, as an outpatient setting. Sociodemographic and clinical data were analyzed in the study as descriptive and explanatory variables. As outcome variables were considered the labor/social security situation and definitive functional sequels. For the evaluation of the definitive functional incapacity the modified Rankin scale was used. Results: The stroke in Roraima has an important personal impact, generating significant disability in those treated with supportive therapy. There was no statistically significant difference in the degree of disability at admission and six months after the reevaluation. There was a significant increase in the demand for government benefits, associated with a significant decrease in personal income and the contribution in family income, due to unemployment and retirement. Conclusion: this study highlights the need and importance of health managers to invest in treatment programs that may modify the natural history of the disease in the state of Roraima, due to its high clinical, social and economic impact.

/pdf/impacto-socioeconomico-do-acidente-vascular-cerebral-no-4m3a3f6l59.pdf

Ana Rosa Ribeiro Fonseca

Papers

Impacto socioeconômico do acidente vascular cerebral no estado de roraima: um estudo de coorte de base hospitalar