Stroke Units: Many Questions, Some Answers

Fuentes, Blanca; Tejedor, E. Díez

doi:10.1111/j.1747-4949.2009.00244.x

Cited by 51 publications

(29 citation statements)

References 92 publications

(109 reference statements)

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“…Every stroke patient can potentially benefit from care in a stroke unit. These units usually are efficient, cost-effective, and their benefits are consistent over time 10 . A Canadian cohort showed that initial assessment by a stroke team reduced stroke case fatality at 7 days, 30 days and 1 year 11 .…”

Section: Discussionmentioning

confidence: 99%

Neurological diagnoses in the emergency room: differences between younger and older patients

Lange

Braatz

Novák

et al. 2011

Arq. Neuro-Psiquiatr.

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Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. Method: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, ≤50 years old and >50 years old. Results: Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the ≤50 years old group. Conclusion: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training. Key words: nervous-system disease, stroke, headache, seizures, emergency medical services, health services epidemiology.Diagnósticos neurológicos na sala de emergência: diferenças entre pacientes jovens e idosos RESUMO Doenças neurológicas são prevalentes na sala de emergência (SE). O objetivo deste estudo é comparar a ocorrência de diagnósticos neurológicos entre pacientes jovens e idosos atendidos na SE de um hospital terciário. Método: Pacientes admitidos na SE que necessitaram avaliação neurológica nas primeiras 24 horas após a admissão foram separados em dois grupos baseados na idade, ≤50 anos de idade e >50 anos de idade. Resultados: Doença cerebrovascular foi o diagnóstico mais comum nos pacientes >50 anos (59,6% vs. 21,8%, p<0,01). Convulsões (8,1% vs. 18,6%, p<0,01) e cefaléias primárias (3,7% vs. 114%, p<0,01) foram mais frequentes no grupo ≤50 anos. Conclusão: O presente estudo demonstrou que esses três diagnósticos neurológicos representam a maioria das avaliações neurológicas na SE. Diretrizes nacionais para os profissionais emergencistas que tratam estas doenças devem ser incluídos na prática clínica e no treinamento médico. Palavras-chave: doença do sistema nervoso, AVC, cefaléia, convulsões, serviço médico de emergência, epidemiologia em serviços de saúde.

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Section: Discussionmentioning

confidence: 99%

Neurological diagnoses in the emergency room: differences between younger and older patients

Lange

Braatz

Novák

et al. 2011

Arq. Neuro-Psiquiatr.

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“…However, the patients who showed a large difference between the rSO 2 values of the diseased hemisphere when compared with the 'healthy' hemisphere had a better outcome. Also, a narrowing of the interhemispheric rSO 2 difference heralded increased swelling, while decompression (by hemicraniectomy) yielded a larger difference in rSO 2 , with positive values on the infarcted side. While the physiological explanation of increased oxygen saturation (rSO 2 ) on the infarcted side may be surprising, and the assessment of rSO 2 values with different monitors has been debated [83,84], the application of oxygenation and CBF parameters by non-invasive OI in patients with malignant stroke seems promising, especially when considering the complicated decision algorithm for invasive therapy [85].…”

Section: (B) Monitoring Malignant Strokementioning

confidence: 99%

“…the last decade has seen major advances in the management of acute stroke. This is largely due to two therapeutic inventions that have been established to improve outcome: causal therapy of the focal ischaemia by thrombolysis [1] and (sub)acute monitoring of patients in specialized stroke units [2,3]. While the focus on the (sub)acute phase of stroke is beneficial beyond doubt, the burden caused by stroke by far outlasts this acute stage.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive optical imaging of stroke

Obrig

Steinbrink

2011

Phil. Trans. R. Soc. A.

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The acute onset of a neurological deficit is the key clinical feature of stroke. In most cases, however, pathophysiological changes in the cerebral vasculature precede the event, often by many years. Persisting neurological deficits may also require long-term rehabilitation. Hence, stroke may be considered a chronic disease, and diagnostic and therapeutic efforts must include identification of specific risk factors, and the monitoring of and interventions in the acute and subacute stages, and should aim at a pathophysiologically based approach to optimize the rehabilitative effort. Non-invasive optical techniques have been experimentally used in all three stages of the disease and may complement the established diagnostic and monitoring tools. Here, we provide an overview of studies using the methodology in the context of stroke, and we sketch perspectives of how they may be integrated into the assessment of the highly dynamic pathophysiological processes during the acute and subacute stages of the disease and also during rehabilitation and (secondary) prevention of stroke.

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“…Son estructuras geograficamente delimitadas con monitorización continua no invasiva, con personal entrenado y coordinado por neurólogos que dirigen un equipo multidisciplinario. Han demostrado, con un nivel de evidencia I, que mejoran la morbimortalidad con un equilibrio coste/eficacia favorable, y reducen las complicaciones y la dependencia 3,4 . La Declaración de Helsinborg, un consenso paneuropeo para el manejo del ictus, recoge que las UI constituyen el cuidado mas efectivo del ictus y la intervención con mayor beneficio comunitario y superan claramente a la trombólisis.…”

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“…La mayoría de los pacientes que han presentado un ictus se benefician de las UI. Por el contrario, el ingreso en una UCI no es eficiente, ya que la inmensa mayoría de los pacientes no precisan este tipo de cuidados 4 .…”

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