Primary care center specialized in cerebrovascular accidents
First experience in Uruguay: preliminary report
Keywords:
STROKE, INTENSIVE CARE UNITSAbstract
Introduction: health care centers specialized in cerebrovascular accidents (CVA) or strokes (CES) aim to improve prevention, health care assistance and rehabilitation of patients affected by CVA.
Objetives: we present our experience along with the strengths and weaknesses found at the First Primary Care Center Specialized in Stroke (CEPS) in Uruguay, developed at the Canelones Medical Cooperative (COMECA) during the first year of work.
Methods: the center provides health care services to adult patients, both in acute phases and during intra-hospital and extra-hospital follow-up. Inclusion criteria: adult patient who were hospitalized at COMECA’s Sanatorio , under three days after the presentation of symptoms, all severity severity levels. It includes subarachnoid hemorrhage (SAH), parenchymatous hemorrhage (PH) and cerebral infarction (INF).
The center is multidisciplinary; activities are completely protocolized and computerized.
Results: 45 patients were included: INF 69%, PH 20% and SAH 11%. Early mortality was 13%, mainly associated to PH and greater severity at stroke onset. Average length of hospital stay was nine days.
Conclusions: the population characteristics and mortality figures are comparable to those of other centers. Length of stay is similar to the best international results. Current results lack epidemiological value, which will be achieved after a certain time.
References
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(25) Hochmann B, Coelho J, Segura J, Galli M, Ketzoian C, Pebet M. Incidencia de accidentes cerebrovasculares en la ciudad de Rivera, Uruguay. Rev Neurol 2006; 43(2): 78-83.
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(27) Braga P, Ibarra A, Rega I, Ketzoian C, Pebet M, Servente L, et al. Prediction of early mortality after acute stroke. J Stroke Cerebrovasc Dis 2002; 11(1): 15-22.
(28) Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Intracerebral hemorrhage versus infarction: stroke severity, risk factors and prognosis. Ann Neurol 1995; 38(1): 45-50.
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(30) Braga P, Botti B, Ibarra A, Rega I, Servente L, Benzano D, et al. Ataque cerebrovascular: un estudio epidemiológico prospectivo en el Hospital de Clínicas de Montevideo. Rev Méd Urug 2001; 17(1): 42-54.
(31) Baptista MV, van Melle G, Bogousslavsky J. Prediction of in-hospital mortality after first-ever stroke: the Lausanne Stroke Registry. J Neurol Sci 1999; 166(2): 107-14.
(32) Jørgensen HS, Nakayama H, Raaschou HO, Larsen K, Hübbe P, Olsen TS. The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay and cost. A community-based study. Stroke 1995; 26(7): 1178-82.
(2) Riggs JE. Changing demographics and neurologic disease in the elderly. Neurol Clin 1996; 14(2): 477-86.
(3) Alberts MJ, Hademenos G, Latchaw RE, Jagoda A, Marler JR, Mayberg MR, et al. Recommendations for the establishment of primary stroke centers. JAMA 2000; 283(23): 3102-9.
(4) Rønning OM, Guldvog B. Stroke units versus general medical wards I: twelve and eighteen-month survival: a randomized, controlled trial. Stroke 1998; 29(1): 58-62.
(5) Flemming KD, Brown RD Jr, Petty GW, Huston J 3rd, Kallmes DF, Piepgras DG. Evaluation and management of transient ischemic attack and minor cerebral infarction. Mayo Clin Proc 2004; 79(8): 1071-86.
(6) Goldstein LB, Bian J, Samsa GP, Bonito AJ, Lux LJ, Matchar DB. New transient ischemic attack and stroke. Arch Intern Med 2000; 160(19): 2941-6.
(7) Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers. Stroke 2005; 36(7): 1597-616.
(8) Faggi A. Definiendo las variables de eficiencia y eficacia de una Unidad de Stroke. Anuario Fundación Dr. J. R. Villavicencio 2006; 14: 081-8.
(9) Organised inpatient (stroke unit) care for stroke (Cochrane Review). In: The Cochrane Library, Issue 1, 2009. Oxford: Update Software.
(10) Hospital Ramos Mejía. Unidad de Stroke. Disponible en: www.ramosmejia.org.ar/stroke.html.
(11) Phillips SJ, Eskes GA, Gubitz GJ; Queen Elizabeth II Health Sciences Centre Acute Stroke Team. Description and evaluation of an acute stroke unit. CMAJ 2002; 167(6): 655-60.
(12) Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial- TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35-41.
(13) Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spotaneous intracerebral hemorrhage in adults. Stroke 2007; 38(6): 2001-23.
(14) Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA, et al. National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol 2006; 60(3): 301-13.
(15) Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38(5): 1655-711.
(16) Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Circulation 2006; 113(10): e409-e449.
(17) Indredavik B, Bakke F, Slordahl SA, Rokseth R, Hâheim LL. Treatment in a combined acute and rehabilitation stroke unit. Stroke 1999; 30(5): 917-923.
(18) Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: A clinical examination scale. Stroke 1989; 20(7): 864-70.
(19) Wiebers DO, Feigin VL, Brown RD Jr. Appendixes: functional status scales. In: Handbook of Stroke. Philadelphia: Lippincott-Raven, 1997: 354-7.
(20) Rankin J. Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scott Med J 1957; 2(5): 200-15.
(21) Wiebers DO, Feigin VL, Brown RD Jr. Appendixes: Functional Status Scales. In: Handbook of Stroke. Philadelphia: Lippincott-Raven, 1997: 357.
(22) Brainin M, Bornstein N, Boysen G, Demarin V. Acute neurological stroke care in Europe: results of the European Stroke Care Inventory. Eur J Neurol 2000; 7(1): 5-10.
(23) Fuentes B, Diez-Tejedor E. Unidades de ictus: una necesidad asistencial coste-efectiva. Neurología 2007; 22(7): 456-66.
(24) Indredavik B, Bakke F, Slordahl SA, Rokseth R, Hâheim LL. Stroke unit treatment: 10 year follow-up. Stroke 1999; 30(8): 1524-7.
(25) Hochmann B, Coelho J, Segura J, Galli M, Ketzoian C, Pebet M. Incidencia de accidentes cerebrovasculares en la ciudad de Rivera, Uruguay. Rev Neurol 2006; 43(2): 78-83.
(26) Favat J, Pebet M, Dalmas F. Enfermedad cerebrovascular isquémica: epidemiología y factores de riesgo. Montevideo: Instituto de Neurología, 1995: 9-12.
(27) Braga P, Ibarra A, Rega I, Ketzoian C, Pebet M, Servente L, et al. Prediction of early mortality after acute stroke. J Stroke Cerebrovasc Dis 2002; 11(1): 15-22.
(28) Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Intracerebral hemorrhage versus infarction: stroke severity, risk factors and prognosis. Ann Neurol 1995; 38(1): 45-50.
(29) Sposato LA, Esnaola MM, Zamora R, Zurrú MC, Fustinoni O, Saposnik G; ReNACer Investigators; Argentinian Neurological Society. Quality of ischemic stroke care in emerging countries: the Argentinian National Stroke Registry (ReNACer). Stroke 2008; 39(11): 3036-41.
(30) Braga P, Botti B, Ibarra A, Rega I, Servente L, Benzano D, et al. Ataque cerebrovascular: un estudio epidemiológico prospectivo en el Hospital de Clínicas de Montevideo. Rev Méd Urug 2001; 17(1): 42-54.
(31) Baptista MV, van Melle G, Bogousslavsky J. Prediction of in-hospital mortality after first-ever stroke: the Lausanne Stroke Registry. J Neurol Sci 1999; 166(2): 107-14.
(32) Jørgensen HS, Nakayama H, Raaschou HO, Larsen K, Hübbe P, Olsen TS. The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay and cost. A community-based study. Stroke 1995; 26(7): 1178-82.
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Published
2009-06-30
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Legnani EJ, Tarigo H, Legnani C, Braga P, Bagés M. Primary care center specialized in cerebrovascular accidents: First experience in Uruguay: preliminary report. Rev. Méd. Urug. [Internet]. 2009 Jun. 30 [cited 2024 Sep. 16];25(2):92-101. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/466
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