Association between the Manchester Triage System and the final outcome in stroke patients

Abstract

ResumoEnquadramento: O acidente vascular cerebral (AVC) é uma das principais causas de morte em Portugal, e a principal causa de incapacidade nos idosos. Torna-se necessário definir estratégias para amenizar os danos. Objetivos: Relacionar a prioridade definida pelo Sistema de Triagem de Manchester para doentes com AVC e o desfecho final (alta/óbito/internamento). Metodologia: Estudo observacional que analisou dados do software ALERT® em todos os doentes com AVC que entraram num serviço de urgência polivalente português entre 2010 e 2012, totalizando 864 casos. Resultados: A maioria dos doentes foi triada com elevada prioridade, sendo as idades diferentes entre homens e mulheres. Prioridades mais elevadas (cor vermelha e laranja) foram atribuídas aos mais idosos, aos que faleceram e aos que foram internados (p < 0,001). Houve reduzida ativação da Via Verde-AVC (14%). Conclusão: Doentes internados e os que faleceram foram triados com prioridades mais elevadas, existindo relação estatística significativa entre as prioridades mais altas (vermelha e laranja), a taxa de internamento e a mortalidade (p < 0,001).Palavras-chave: acidente vascular cerebral; enfermagem; serviços médicos de emergência; triagem; evolução clínica Abstract Background: Stroke is one of the leading causes of death in Portugal, and the leading cause of disability in older people. Strategies should be established to mitigate damages. Objectives: To establish an association between the priority defined by the Manchester Triage System for stroke patients and the final outcome (discharge/death/hospitalization). Methodolog y: An observational study was conducted to analyze data from the ALERT® software in all stroke patients who were admitted to a Portuguese multipurpose emergency department between 2010 and 2012, in a total of 864 cases. Results: Most patients were triaged with high priority, and the ages differed between men and women. Higher priorities (red and orange) were assigned to older persons and patients who eventually died or were hospitalized (p < 0.001). The Via Verde do AVC program was seldom activated (14%). Conclusion: Inpatients and those who eventually died were triaged with higher priorities. A statistically significant association was found between the highest priorities (red and orange), hospitalization rate, and mortality (p < 0.001).

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research

“…The perception of delay in attendance was frequent both in the initial assistance and in waiting for beds, or in the team's decisions. The delay postpones decision making for the application of thrombolytic drugs, while the recommended time for this procedure is, at most, four hours and thirty minutes after stroke (22)(23) . Literature reports perceptions of delays in seeking treatment after the first symptoms as well as doubts about the diagnosis and quality of care in different countries (9,12,21) .…”

Triagem e ativação da via verde do acidente vascular cerebral: dificuldades sentidas pelos enfermeiros

“…A colheita de dados ocorreu por meio da aplicação de um questionário estruturado e desenvolvido pelos pesquisadores, após prévio levantamento de dados bibliográficos acerca das principais dificuldades enfrentadas pelos profissionais no processo de triagem, especialmente do AVC (11,12,15,16,19) . Em seguida, este foi revisto por três enfermeiros especialistas (um em enfermagem médico-cirúrgica, outro em enfermagem comunitária e ainda outro em enfermagem de reabilitação), que, de forma independente, avaliaram o instrumento e fizeram adequações gramaticais e de conteúdo necessárias para a melhor compreensão dos respondentes.…”

Results of the implementation of the code stroke protocol in a Portuguese hospital

“…During the triage of the person with a suspected stroke, the importance of the role of the nurse is all too evident. It depends on the strict, quick, and efficient activation of the intra-hospital code stroke protocol, provided that the patient presents at least one of the classic focal signs of the Cincinnati Scale (arm drift, facial droop, and slurred speech; Jauch et al, 2013;Pereira, Guedes, Oliveira, & Martins, 2017). The identification of the signs of the Cincinnati Scale was the first stage of the decision-making process, followed by the evaluation of the following inclusion criteria: age above 18 years old; symptom onset for less than 4.5 hours; and absence of prior dependence.…”