Stroke management in a university hospital in the largest South American city

Conforto, Adriana Bastos; Paulo, Rodrigo Bomeny de; Patroclo, Cristiane Borges; Pereira, Samira Luisa dos Apostolos; Miyahara, Helder de Souza; Fonseca, Camila Barião da; Yamamoto, Fábio Iuji; Marchiori, P E; Evaristo, Eli Faria; Scaff, Milberto

doi:10.1590/s0004-282x2008000300004

Cited by 22 publications

(19 citation statements)

References 17 publications

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“…4,6,8,21,30 Prestroke disability (mRS Ͼ3) was also an independent predictor of poor outcome in our series. Measures to assure more efficacious control of risk factors like gratuitous distribution of antihypertensive medications and adequate identification and treatment for patients with atrial fibrillation and carotid stenosis could have a tremendous impact in lowering the risk of stroke recurrence.…”

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

confidence: 48%

“…This explanation is supported by a study done in a large academic hospital in São Paulo, in which all patients with ischemic stroke had a complete work-up if admitted to the neurology wards, whereas only 33% if admitted to the emergency department. 6 Another explanation for the incomplete evaluation of our patients could be the unavailability of diagnostic tests in some of the hospitals studied.…”

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

confidence: 97%

“…6,32,33 Higher quality of care during the early phase of stroke was shown to be associated with shorter length of stay. 34 Delays in complimentary evaluations is the most feasible explanation for the prolonged admission time in our patients, which not only significantly increases the costs for stroke care, but also increases the risks for infection, deep vein thrombosis, and recurrence in patients with suboptimal treatment and evaluation.…”

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

confidence: 99%

“…The overall thrombolysis rate in our patients was below that of developed countries and much lower than those of reference stroke centers. 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.…”

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

115

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

confidence: 48%

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

confidence: 97%

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

confidence: 99%

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

confidence: 99%

See 2 more Smart Citations

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

Carvalho

Alves

Viana

et al. 2011

Stroke

115

View full text Add to dashboard Cite

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“…O tratamento com a rtPA é subutilizado no mundo todo 8,9,10 , inclusive no Brasil 11,12 seja por extrapolar o tempo máximo para administração de 4,5 horas após o início dos sintomas (janela terapêutica 13 ), seja por ser desconhecida (liberação relativamente recente), ou por aumentar a probabilidade de hemorragia 7 .…”

Section: Introductionunclassified

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

et al. 2013

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O acidente vascular cerebral isquêmico (AVCi) é uma importante causa de sequela e morte. A correta utilização do trombolítico enfrenta várias barreiras. O objetivo foi discutir as barreiras à terapia trombolítica em pacientes que chegam, com sintomas de AVCi agudo, à emergência de um hospital privado do Rio de Janeiro, Brasil. Coorte retrospectiva de pacientes entre 2009 e 2011. Foram admitidos 257 pacientes com suspeita de AVCi. Dos pacientes com diagnóstico confirmado (156), 11,5% (18) foram trombolisados. Dos 30 pacientes com diagnóstico de AVCi, dentro da janela terapêutica e com NIHSS na faixa para trombólise, 20 não foram trombolisados, 9 por barreiras administrativas (45%). Neste trabalho o percentual de trombólise foi superior ao observado nos Estados Unidos, mas barreiras impediram o tratamento de 45% dos pacientes com indicação à trombólise. Imagina-se que na rede pública brasileira a situação seja ainda mais desfavorável.

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Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack

et al. 2019

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IMPORTANCE Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low-and middle-income countries. OBJECTIVE To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. DESIGN, SETTING AND PARTICIPANTS This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. INTERVENTIONS The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. MAIN OUTCOMES AND MEASURES The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). RESULTS A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, −3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). CONCLUSIONS AND RELEVANCE A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies.

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Stroke management in a university hospital in the largest South American city

Cited by 22 publications

References 17 publications

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

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

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack

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