Time of presentation of stroke patients in São Paulo Hospital

Leopoldino, José Fábio Santos; Fukujima, Márcia Maiumi; Silva, Gisele Sampaio; Prado, Gilmar Fernandes do

doi:10.1590/s0004-282x2003000200005

Cited by 17 publications

(19 citation statements)

References 10 publications

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“…4,20,21 Conversely, as compared with other national and international studies, investigation of stroke etiology was less common, time to neuroimaging and time to hospital admission were increased, treatment with thrombolysis was less frequent, and frequency of poststroke disability was higher. 4,5,[22][23][24][25][26][27] Our findings of frequent incomplete investigation of stroke etiology and worse stroke outcomes corroborate our hypothesis that the previous studies performed in Brazil on stroke epidemiology and patterns of treatment were not representative of the country as a whole.…”

Section: Discussionsupporting

confidence: 87%

“…6,22,23 In Brazil, the percentage of patients who have access to thrombolysis is quite low aside from a few strategic, and mostly private, hospitals located in the southeast and south regions, the wealthiest regions of the country. 5,6,35 Most patients with stroke in Brazil are treated in public hospitals, where protocols for the use of thrombolysis are not routinely available. 35,36 Another obstacle to thrombolysis in Brazil is the lack of lay knowledge, even in individuals with a higher level of education, higher socioeconomic status, and private healthcare coverage, about stroke signs and symptoms leading to delays in hospital admission.…”

Section: De Carvalho Et Al Hospital-based Prospective Study In Brazilmentioning

confidence: 99%

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Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil

Carvalho

Alves

Viana

et al. 2011

Stroke

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116

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Background and Purpose-Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil. Methods-Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010. Results-We evaluated 2407 consecutive patients (mean age, 67.7Ϯ14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8 -32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2-26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score Յ2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome. Conclusions-The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series.Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality. (Stroke. 2011;42:3341-3346.)

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Section: Discussionsupporting

confidence: 87%

Section: De Carvalho Et Al Hospital-based Prospective Study In Brazilmentioning

confidence: 99%

Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil

Carvalho

Alves

Viana

et al. 2011

Stroke

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116

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“…Indeed, the majority of patients with stroke in Brazil are treated in public hospitals under the national public healthcare system, where tissue plasminogen activator is not yet readily available for the treatment of stroke. 5,6 Moreover, access to stroke reperfusion therapy may also be hindered by the lack of knowledge about stroke and its treatment. Lay knowledge about stroke, which may contribute significantly to delay in hospital admission, has not yet been adequately addressed in a community-based study in Brazil.…”

mentioning

confidence: 99%

Stroke Awareness in Brazil

Pontes-Neto

Silva

Feitosa

et al. 2008

Stroke

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158

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Background and Purpose-Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil. Methods-The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home. Results-Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (Pϭ0.038, ORϭ1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (PϽ0.05, ORϭ2.0, 95% CI: 1.2 to 3.2) more often than those with lower education. Conclusions-Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies. (Stroke. 2008;39:292-296.)

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“…A avaliação na urgência inclui ainda a estabilização das condições vitais do paciente, tais como cuidados respiratórios, balanço hidroeletrolítico, monitorização hemodinâmica, codições dietéti-cas, controle rigoroso da temperatura e da glicemia e prevenção de trombose venosa profunda 11 . Em estudo realizado no Hospital São Paulo (HSP) no período de 1998 a 1999, antes da utilização de trombolítico, verificou-se o grande intervalo de tempo no atendimento a pacientes com diagnóstico de AVC, mostrando que a doença não era considerada emergência médica 10 . Este estudo visa caracterizar os pacientes víti-mas de AVCI agudo atendidos num hospital universitário terciário quanto ao tempo decorrido até o atendimento, o fluxo interno e as principais complicações.…”

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Paciente com acidente vascular cerebral isquêmico já é atendido com mais rapidez no Hospital São Paulo

Yamashita

Fukujima

Granitoff

et al. 2004

Arq. Neuro-Psiquiatr.

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, Gilmar Fernandes do Prado 2RESUMO -Foram caracterizados os pacientes com diagnóstico de acidente vascular cerebral (AVC) isquêmico internados por período superior a 24 horas. Investigamos os fatores que influenciam a chegada precoce ou tardia do paciente ao pronto socorro, o intervalo de tempo entre a chegada e a realização de tomografia computadorizada (TC), os fatores que influenciam na permanência destes pacientes no hospital e o seu destino. Concluímos que a população atendida pelo Hospital São Paulo tem chegado ao hospital mais precocemente que há 3 anos (47% chegaram nas primeiras 3 horas de instalação) e que o fluxo interno do paciente ficou muito mais rápido, uma vez que o AVC é considerado emergência médica pela equipe de saúde. As principais complicações apresentadas pelos pacientes foram infecciosas e nos direcionam à proposta de implementação de protocolos para a melhoria aos cuidados que devem ser prestados pelos profissionais de saúde. PALAVRAS-CHAVE: acidente vascular cerebral, isquemia cerebral, complicações. Patients with ischemic stroke are taken care quickly in São Paulo HospitalABSTRACT -We observed inpatients with the diagnosis of ischemic stroke hospitalized at least 24 hours. We investigated the reasons for early or late arrival to the Emergency Room, the time span from arrival to computed tomography (CT) scanning, factors associated to hospitalization time, and patients outcome. We concluded that people who are cared for by São Paulo Hospital now get to the hospital sooner than they did 3 years ago (47% arrived in 3 hours or less) and that the patient flow inside the hospital became much faster, once any stroke patient is considered now a medical emergency by the hospital staff. Infections were the main complications presented by our patients, which is leading us to optimize protocols to improve emergency care by all the staff.

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Time of presentation of stroke patients in São Paulo Hospital

Cited by 17 publications

References 10 publications

Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil

Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil

Stroke Awareness in Brazil

Paciente com acidente vascular cerebral isquêmico já é atendido com mais rapidez no Hospital São Paulo

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