Stroke study group: preliminary results early intensive care improves functional outcome

Abstract

SUMMARY -Early and intensive care seems to positively affect outcome in stroke patients. A standardized protocol, costly adjusted to our reality and suitable for application by non-specialist at Emergency Room, proved effective, reflecting in diagnosis reliability, reducing time for beginning therapy, leading to low mortality rates and better functional outcomes at discharge.KEY WORDS: stroke, treatment, functional outcome, mortality.Acidente vascular encefálico isquêmico: protocolo para atendimento precoce; redução da mortalidade e morbidade RESUMO -Evidências atuais enfatizam a necessidade de tratamento precoce para os acidentes vasculares encefálicos isquêmicos, numa tentativa de reverter o quadro metabólico que se desenvolve nas primeiras horas após sua instalação. Objetivando reduzir custos, aumentar a eficiência das medidas diagnósticas e terapêuticas, além de reduzir o tempo de início do tratamento, um protocolo de ação vem sendo sistematicamente aplicado em nosso Hospital desde setembro-1992. Após seu primeiro ano de uso, com 157 pacientes consecutivos atendidos, houve uma redução na mortalidade imediata e, principalmente, significativa redução na morbidade, com evidente melhora na qualidade de sobrevida de nossos pacientes.PALAVRAS CHAVE: acidente vascular encefálico isquêmico, tratamento, morbidade, mortalidade.Rather than mortality, recovery from stroke is hallmarked by functional improvement. Recent evidences pointing to a trend in mortality reduction 3 need, to have greater social impact, be followed by a parallel decline in stroke morbidity. There is no concern about proper management in acute phase of stroke 2 , 1 7 , 2 0 : despite these controversies, early intensive care seems to result in better outcomes, whether consequence of some specific therapeutic measure or of the whole rational treatment 5,13 . Experimental data points to a "therapeutic window", a time-related interval in which neurons functionally inactive might be restored if adequate conditions are provided 6 , 8 , 2 1 . Precise duration of this interval remains speculative but, it seems reasonable to suppose with some confidence, from animal data, that it is not far from 6 to 8 hours 19 . In our country, first aid for stroke sufferers are provided usually by a non-specialist, an internist; and he is the fortunate "therapeutic window guest".Delay in time-to-start therapy must account, at least partially, for some deterioration in cellular condition, spreading damage to adjacent "ischemically threatened neurons", rendering their potentially recovering state to a irreversible one, with necrosis and worsening functional outcome 18 . So, functional outcome serves as a sensitive marker to estimate extension and progression of ischemic process.