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Academia Mexicana de Neurología, A.C.

2007, Number 1

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Rev Mex Neuroci 2007; 8 (1)

Prehospital events and in-hospital mortality after acute stroke

Chiquete E, Ruiz-Sandoval JL

Language: Spanish
References: 34
Page: 41-48
PDF size: 378.71 Kb.


ABSTRACT

Background: After suffering stroke, early arrival to hospital is mandatory for adequate management. Objective: We aimed to identify factors influencing hospital arrival and prehospital events associated with in-hospital mortality of patients with acute stroke, before the establishment of a stroke unit and outside of clinical trials. Methods: A first-step stroke surveillance system was conducted on 94 consecutive patients. Prehospital delay of ‹ 3 hours from stroke onset and in-hospital mortality were the main research outcomes. Independent predictors were identified by logistic regression. Results: Twenty-five percent of patients arrived in ‹ 3 hours; corresponding to 38, 27 and 13% for ischaemic stroke, subarachnoid haemorrhage and intracerebral haemorrhage, respectively. Age ≥ 65 years (OR: 2.80; 95% CI: 1.31-4.61) and stroke occurring in the night (OR: 2.22; 95% CI: 1.07-3.60) predicted arrival in ‹ 3 hours. Prehospital factors predicting in-hospital mortality were arrival on ambulance (OR: 7.10; 95% CI: 3.23-9.93) indicating delay in first-aid posts, impaired consciousness at stroke onset (OR: 2.43; 95% CI: 1.49-3.04), and having › 1 risk factor for stroke (OR: 2.12; 95% CI: 1.18- 2.84). Conclusions: The use of first-aid services did not improve prehospital delay due to temporal retention of the patients with acute stroke in these units before the definite arrival to our center. Hence, some prehospital factors influence in-hospital mortality in acute stroke.


REFERENCES

  1. Baum HM. Stroke prevalence: an analysis of data from the 1977 National Health Interview Survey. Public Health Rep 1982; 97: 24-30.

  2. O’Mahony PG, Thomson RG, Dobson R, Rodgers H, James OF. The prevalence of stroke and associated disability. J Public Health Med 1999; 21: 166-71.

  3. Saposnik G, Del Brutto OH. Stroke in South America, a systematic review of incidence, prevalence, and stroke subtypes. Stroke 2003; 34: 2103-8.

  4. Ayala C, Croft JB, Keenan NL, Neff LJ, Greenlund KJ, Donehoo RS, et al. Increasing trends in pre-transport stroke deaths-United States, 1990-1998. Ethn Dis 2003; 13: 131-7.

  5. Hankey GJ, Warlow CP. Treatment and secundary prevention of stroke: evidence, costs and effects on individuals and populations. Lancet 1999; 354: 1457-63.

  6. Caro JM, Huybrechts KF. Stroke Treatment Economic Model (STEM), Predicting Long-Term Costs From Functional Status. Stroke 1999; 30: 2574-9.

  7. Hantson L, Gheuens J, Tritsmans L, De Keyser J. Hospital referral of stroke patients: a survey of attitudes in general practice, and consideration of entry times for clinical trials. Clin Neurol Neurosurg 1994; 96: 32-7.

  8. Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005; 352: 777-85.

  9. Mayer SA. Ultra-Early Hemostatic Therapy for Intracerebral Hemorrhage. Stroke 2003; 34: 224-9.

  10. Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, et al. Early stroke treatment associated with better outcome. The NINDS rt-PA Stroke Study. Neurology 2000; 55: 1649-55.

  11. Evenson KR, Rosamond WD, Morris DL. Prehospital and in-hospital delays in acute stroke care. Neuroepidemiology 2001; 20: 65-76.

  12. Nedeltchev K, Arnold M, Brekenfeld C, Isenegger J, Remonda L, Schroth G, et al. Pre- and in-hospital delays from stroke onset to intra-arterial thrombolysis. Stroke 2003; 34: 1230-4.

  13. Harraf F, Sharma AK, Brown MM, Lees KR, Vass RI, Kalra L. A multicentre observational study of presentation and early assessment of acute stroke. BMJ 2002; 325: 17.

  14. Derex L, Adeleine P, Nighoghossian N, Honnorat J, Trouillas P. Factors influencing early admission in a French stroke unit. Stroke 2002; 33: 153-9.

  15. Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F. The global stroke initiative. Lancet Neurol 2004; 3: 391-3.

  16. Zhang J, Yu KF. What’s the relative risk? JAMA 1998; 280: 1690-1.

  17. Cepeda MS, Boston R, Farrar JT, Strom BL. Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders. Am J Epidemiol 2003; 158: 280-7.

  18. Tan TY, Chang KC, Liou CW. Factors delaying hospital arrival after acute stroke in southern Taiwan. Chang Gung Med J 2002; 25: 458-63.

  19. Lupi-Herrera E. National Registry of Acute Ischemic Coronary Syndromes (RENASICA). Mexican Cardiology Society. The RENASICA Cooperative Group [in Spanish]. Arch Cardiol Mex 2002; 72: 45-64.

  20. Svensson L, Karlsson T, Nordlander R, Wahlin M, Zedigh C, Herlitz J. Implementation of prehospital thrombolysis in Sweden: components of delay until delivery of treatment and examination of treatment feasibility. Int J Cardiol 2003; 88: 247-56.

  21. Estadísticas sobre mortalidad general. Secretaría de Salud, México, 2004. Ingresado en septiembre 23 de 2006. (http:/ /www.salud.gob.mx/).

  22. Sudlow CL, Warlow CP. Comparing stroke incidence worldwide: what makes studies comparable? Stroke 1996; 27: 550-8.

  23. Lavados PM, Sacks C, Prina L, Escobar A, Tossi C, Araya F, et al. Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project). Lancet 2005; 365: 2206-15.

  24. Srivastava AK, Prasad K. A study of factors delaying hospital arrival of patients with acute stroke. Neurol India 2001; 49: 272-6.

  25. Yoneda Y, Mori E, Uehara T, Yamada O, Tabuchi M. Referral and care for acute ischemic stroke in a Japanese tertiary emergency hospital. Eur J Neurol 2001; 8: 483-8.

  26. Goldstein LB, Edwards MG, Wood DP. Delay between stroke onset and emergency department evaluation. Neuroepidemiology 2001; 20: 196-200.

  27. Lira-Mamani D, Concha-Flores G. Factores asociados al tiempo de llegada de pacientes con enfermedad cerebrovascular al servicio de urgencias de un hospital peruano. Rev Neurol 2004; 39: 508-12.

  28. Zweifler RM, Mendizabal JE, Cunningham S, Shah AK, Rothrock JF. Hospital presentation after stroke in a community sample: the Mobile Stroke Project. South Med J 2002; 95: 1263-8.

  29. Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke 2001; 32: 63-9.

  30. Cheung RT. Hong Kong patients’ knowledge of stroke does not influence time-to-hospital presentation. J Clin Neurosci 2001; 8: 311-4.

  31. Menon SC, Pandey DK, Morgenstern LB. Critical factors determining access to acute stroke care. Neurology 1998; 51: 427-32.

  32. Chang KC, Tseng MC, Tan TY. Prehospital delay after acute stroke in Kaoshiung, Taiwan. Stroke 2004; 35: 700-4.

  33. Kay R, Woo J, Poon WS. Hospital arrival time after onset of stroke. J Neurol Neurosur Psych 1992; 55: 973-4.

  34. Evenson KR, Schroeder EB, Legare TB, Brice JH, Rosamond WD, Morris DL. A comparison of emergency medical services times for stroke and myocardial infarction. Prehosp Emerg Care 2001; 5: 335-9.




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