Stroke health care plan (ICTUS II. 2010)

Masjuán, Jaime; Álvarez-Sabín, José; Arenillas, Juan F.; Calleja, Sergio; Castillo, José; Dávalos, Antonio; Tejedor, E. Díez; Freijo, Mar; Gil‐Núñez, A.; Fernández, J.C. López; Maestre, J.; Martínez‐Vila, E.; Morales, A.; Purroy, Francisco; Ramírez, Juan Camilo; Segura, Tomás; Serena, Joaquı́n; Tejada, J.; Tejero, Carlos

doi:10.1016/j.nrleng.2010.05.001

Cited by 40 publications

(9 citation statements)

References 112 publications

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“…They all follow the same guidelines [9][10][11] and also the project's recommendations to guarantee quality management. All these centres have work programmes that are co-ordinated with other specialists, clinical pathways and diagnostic-treatment protocols and nursing protocols [11].…”

Section: Design and Study Populationmentioning

confidence: 99%

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Purroy¹,

Vena²,

Forné³

et al. 2019

Cerebrovasc Dis

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Background: In-hospital stroke death rate is an important sanitary issue. Despite advances in the acute phase management of stroke patients, mortality and disability rates remain high. In aging populations and with different mortality between the sexes in general, the study of sex- and age-related differences becomes increasingly relevant for optimization of post-acute clinical care of stroke patients. Methods: We designed a cohort follow-up study with 13,932 consecutive ischemic stroke (IS) patients from 19 Spanish hospitals. Data was obtained from the Spanish Stroke Registry; transient ischemic attacks and ages <18 years were excluded. Patients were organised by age group and sex. We compared female and male patient cohorts within and across age groups univariately and used multivariable logistic regression to adjust for confounders in differential in-hospital mortality. Results: The median (percentiles 2.5 and 97.5%) age was 78 (41–92) years old for women and 71 (41–92) for men. IS women were more likely to be older, to exhibit cardio-embolic aetiology, and less likely to have been admitted to a stroke unit or to have had a stroke code activated. Both pre-stroke modified Rankin Scale and National Institute of Health Stroke Scale (NIHSS) scores at admission increased significantly with age and were higher in women than those in men. Differences in distributions of common risk factors for IS and of in-hospital outcomes between women and men actually changed with patient’s age. It is to be noted here that although there were no statistically significant differences (p > 0.05) between the sexes within any age group, in-hospital mortality appeared significantly higher in women than that in men when analysed overall, due to confounding. Death was more closely related to stroke in women than in men and occurred earlier. Although there were some age-specific sex differences between the predictors for in-hospital mortality, stroke severity measured by NIHSS was the main predictor of in-hospital mortality for both sexes. Topographic classifications – partial anterior circulatory infarct and total anterior circulatory infarct – were significant prognostic factors for men aged <60 years and for those in the 60–69 years range respectively. Conclusion: Although most of our findings were consistent with previous studies, it is important to take into account and highlight differences in in-hospital mortality between the sex and age group. Not to account for age-related differences between the sexes can give false results that may mislead management decisions. As most deaths in women were related to stroke, it is important to improve their early management, stroke code activation, access to stroke units and/or revascularisation therapies, especially in the older age groups.

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Section: Design and Study Populationmentioning

confidence: 99%

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Purroy¹,

Vena²,

Forné³

et al. 2019

Cerebrovasc Dis

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“…Stroke is a severe and frequent clinical event. Early care by neurologists has been shown to be related to better functional prognosis and shorter hospital stays [1–4]. The development of stroke units (SU) has been a milestone in providing care for patients who have suffered strokes, as these units have been shown to be the most effective model for providing stroke care when compared to general wards and stroke teams [5].…”

Section: Introductionmentioning

confidence: 99%

Off‐hour effects on stroke care and outcome in stroke centres

Martínez-Martínez

Fernández-Travieso

Fuentes

et al. 2012

Euro J of Neurology

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Background and purpose: Poorer stroke care processes and outcomes have been reported for acute stroke patients arriving at centres during off hours and weekends. Objective: To compare each step of the continuous specialized care that Stroke Centres (SC) provide according to time of admission and final outcome. Methods: Observational study of consecutive stroke patients admitted to SC during 2008 and 2009. Patients were classified into two groups according to their arrival time: Work Hours (WH) and Off Hour (OH) (weekends and any time other than 8:00 am to 3:00 pm on weekdays). Differences in time to diagnostic procedures, tPA administration, stroke outcome [modified Rankin Scale, (mRS)] and in‐hospital fatality rates were analysed. Results: A total of 912 patients were admitted. Data from 674 patients fulfilling study criteria were analysed. A total of 434 (64.4%) patients arrived during OH. No differences in stroke severity were found when comparing OH and WH. Time to blood test results was higher for WH (median 67 min vs. 47 min; P < 0.01), but time to cranial CT scan was similar. Intravenous tPA was administered to 58 (16.4%) OH vs. 26 (13.1%) WH patients (P = 0.33). OH arrival was not associated with poorer outcome (mRS ≥ 3) at discharge (32.8% vs. 37%; P = 0.27), or at the 3‐month follow‐up (30.6% vs. 27.6%, P = 0.52). No differences were found for in‐hospital fatality rates (5.8% vs. 5.4%, P = 1.00). Conclusions: The care provided by SC with neurologists on call 24/7 prevents differences in outcomes associated with time of admission and guarantees equal attention to stroke patients.

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“…Debe perseguirse la equidad en el acceso a estos tratamientos. Se recomienda la disponibilidad de una cama monitorizada en la UI por cada 100.000 habitantes y una isocrona de 60 min atendida por una UI 11,12 . En una encuesta reciente 13 se detectaron 39 UI en España, pero existen comunidades en las que el número de camas disponibles por habitante es claramente insuficiente o en algunos casos inexistente.…”

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“…En una encuesta reciente 13 se detectaron 39 UI en España, pero existen comunidades en las que el número de camas disponibles por habitante es claramente insuficiente o en algunos casos inexistente. También es conocida la infrautilización del tratamiento trombolítico, del que se benefician tan solo un 5% de los afectados 11,12 , lo que en muchos casos refleja la falta de médicos especializados en su administración o la deficiencia en los circuitos asistenciales, lo que impide el acceso urgente a este recurso.…”

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“…El sistema organizativo debe asegurar una atención equitativa, continuada y de calidad para todos los pacientes durante el proceso de su enfermedad, independiente de su localización geográfica. Por ello, debe integrar los avances científico-técnicos conseguidos en el tratamiento de la enfermedad cerebrovascular, con la implementación de estructuras organizativas adecuadas 11,12,14 . Hemos superado el nihilismo de hace unos años, pero debemos conseguir que los pacientes se beneficien de las medidas que la evidencia científica aporta.…”

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Ictus isquémico: nihilismo, evidencia y equidad

Martí‐Fàbregas

2013

Revista Clínica Española

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Stroke health care plan (ICTUS II. 2010)

Cited by 40 publications

References 112 publications

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Off‐hour effects on stroke care and outcome in stroke centres

Ictus isquémico: nihilismo, evidencia y equidad

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