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Abstract(s)
Objetivo: Este estudo foi elaborado com o objetivo de determinar os fatores que levam ao comparecimento tardio no hospital, abrangendo dois centros hospitalares em diferentes regiĂ”es do paĂs, interior/centro e litoral/norte, avaliando fatores prĂ© e intra-hospitalares.
MĂ©todos: Foram inquiridos 154 pacientes dos que se encontravam no internamento dos centros hospitalares Cova da Beira e Entre Douro e Vouga durante o perĂodo em que decorreu a investigação. Tempo prĂ©-hospitalar foi definido como o tempo desde o inĂcio dos sintomas atĂ© ĂĄ chegada ao hospital. O tempo intra-hospitalar foi definido desde a hora de chegada atĂ© Ă hora em que o paciente foi observado pelo mĂ©dico.
Resultados: Foram estudados resultados de um total de 154 pacientes que apresentavam sinais ou sintomas de acidente vascular cerebral aguda. Destes, 57.8 % do sexo masculino e 42.2% dos pacientes do sexo feminino. A mĂ©dia de idades da população foi de 73 anos (73.79) e 52.6% dos pacientes chegaram dentro das 3 horas desde o inĂcio das manifestaçÔes do evento. Neste estudo, 118 pacientes tinham mais de 65 anos. Apenas 20.1% dos pacientes nĂŁo apresentaram quaisquer antecedentes patolĂłgicos de risco para ocorrĂȘncia do AVC, apresentando a restante população = 1 fator de risco dos considerados no questionĂĄrio. O sintoma mais frequente foi a paresia muscular (64.9%) e 36.4% dos pacientes ligaram para o serviço de emergĂȘncia (112). A ativação das Vias Verdes ocorreu em 50% dos casos, e desses, 81.8% chegaram no tempo de janela para terapĂȘutica, as 3 horas. A mĂ©dia do tempo intra-hospitalar foi de 22 minutos, e para avaliação a janela de tempo foi dividida em tempos categĂłricos, mostrando a predominĂąncia entre os 11 e 20 minutos atĂ© um paciente ser observado por um mĂ©dico desde a entrada no hospital. Num total de 154 pacientes, 89% foram admitidos com diagnĂłstico de AVC isquĂ©mico, e os restantes 11% com acidente vascular hemorrĂĄgico.
ConclusĂŁo: O tratamento precoce Ă© um determinante crĂtico de melhor prognĂłstico do AVC agudo. Neste estudo, 48% dos pacientes chegaram fora do intervalo de tempo recomendado para a intervenção mĂ©dica (=3 horas). Tempos prĂ©-hospitalares mais curtos foram estatisticamente significativamente associados a presença de sintomas da fala, utilização do serviço de emergĂȘncia (112), a ativação das Vias Verdes e o valor maior do NIHSS do paciente na admissĂŁo no SU. Como fatores de atraso foram estabelecidos alvos como a ocupação do paciente, a dislipidemia e os sintomas de visĂŁo como manifestaçÔes de um AVC. Destas variĂĄveis, algumas apenas demonstraram relevĂąncia estatĂstica para determinada população, nomeadamente a dislipidemia e as manifestaçÔes da visĂŁo no AVC como fatores de atraso na chegada ao hospital no CHDV. NĂŁo se estabeleceu nenhuma relação com significĂąncia estatĂstica entre o tipo de AVC e uma chegada mais breve ao hospital.
Concluiu-se neste estudo que perante um AVC deve-se de imediato chamar o 112, verificando-se uma relação com significĂąncia estatĂstica em ambos os hospitais. Dado que, apenas 37% dos pacientes usaram o INEM quando presenciaram o AVC, este Ă©, portanto, um ponto de intervenção importante: dar a conhecer ao pĂșblico de que a chamada para o 112 Ă© a primeira ação a ter quando surgem as manifestaçÔes de um AVC (14,18).
Quanto ao tempo intra-hospitalar, a Ășnica relação que se estabeleceu como fator para um tempo intra-hospitalar mais curto foi com a ativação das vias verdes, sem diferenças entre os dois centros hospitalares em estudo.
Os resultados indicam que campanhas educacionais sĂŁo necessĂĄrias para aumentar o conhecimento pĂșblico dos sinais de um AVC e da necessidade de ligar para o 112 imediatamente quando as pessoas estĂŁo possivelmente a sofrer um AVC. Estas atitudes, apesar de algumas diferenças nos resultados entre hospitais, demonstraram ser importantes para a população em geral, sendo o objetivo dar a conhecer a toda a comunidade os fatores de risco, sinais e sintomas, e o que fazer de imediato perante um AVC. Da mesma forma, os mĂ©dicos e hospitais devem ser treinados para o reconhecimento rĂĄpido dos sintomas e sinais, e tambĂ©m para atuar rapidamente, organizados e em equipa no atendimento de um paciente com AVC.
Objective: This study was designed with the aim of determining the factors that lead to patientsâ delayed arrivals at hospitals. To do so two hospital centers in different regions of the country were chosen: one in the interior/center and one in the coastal/ north of the country. Both pre-hospital and intra-hospital factors were evaluated. Methods: 154 patients were surveyed during the period in which the investigation of which were in the inpatient hospital in the hospitals of Cova da Beira and Entre Douro e Vouga. Pre-hospital time was defined as the time from the onset of symptoms to arrival at the hospital. The intra-hospital time was defined as the time from arrival at the hospital until the time the patient was seen by the doctor. Results: the 154 patients that were surveyed were diagnosed with signs or symptoms of acute cerebrovascular accidents. Of those 57.8 % were male and 42.2 % were female. The average age of this population was 73 (73.79) and 52.6% of the patients arrived within 3 hours from the onset of the condition. In this study, 118 patients were over 65 years. Only 20.1% of patients did not show any pathological antecedents of risk for the occurrence of stroke, with the remaining population = 1 risk factor considered in the questionnaire. The most frequent symptom was muscle paresis (64.9%) and 36.4 % of patients called for emergency service (112). Activation of fast tracks occurred in 50 % of cases, and of those, 81.8% arrived on time window for therapy, the 3 hours. The average intra-hospital time was 22 minutes, and the window time was divided into categories, showing the predominance of 11 and 20 minutes for a patient to be seen by a doctor since entering the hospital. A total of 154 patients, 89% were admitted with a diagnosis of ischemic stroke, and the remaining 11% with hemorrhagic stroke. Results: the 154 patients that were surveyed were diagnosed with signs or symptoms of acute cerebrovascular accidents. Of those 57.8% were male and 42.2 % were female. The average age of this population was 73 (73.79) and 52.6% of the patients arrived within 3 hours from the onset of the condition. In this study, 118 patients were over 65 years. Only 20.1% of the patients did not show any pathological antecedents of risk of the occurrence of a stroke, with the remaining population = 1 risk factor considered in the questionnaire. The most frequent symptom was muscle paralysis (64.9%). 36.4 % of the patients called for emergency service (112). Activation of fast tracks occurred in 50 % of cases, and of those, 81.8 % arrived on time window for therapy, the 3 hours. The average intra-hospital time was 22 minutes, and the window time was divided into categories, showing the predominance of 11 to 20 minutes for a patient to be seen by a doctor since entering the hospital. 89% of the 154 patients were admitted with a diagnosis of ischemic stroke, and the remaining 11% with hemorrhagic stroke. Conclusion: Rapid treatment is a determinant factor for a better prognosis of an acute stroke. In this study, 48% of the patients arrived outside the range of the recommended time for medical intervention (= 3 hours). Shorter prehospital times were statistically significantly associated with the presence of symptoms of speech, use of emergency services (112), activation of fast tracks and the highest value of the NIHSS on admission of the patient in the ED. Delay factors such as the occupation of the patient, dyslipidemia and symptoms of vision as manifestations of a stroke were established. Only some showed statistical significance for the given population, including dyslipidemia and manifestations of vision in stroke as factors of delay in arrival at the hospital in CHDV. No relationship with statistical significance between the type of stroke and a shorter hospital arrival was established. It was concluded, that a patient with stroke symptom should call 112 immediately, as there was a statistical significance in both hospitals. Given that only 37% of patients used the INEM when they were faced with a stroke, this is therefore an important point of intervention: to inform the public that the call to 112 is the first action to take when they stroke manifestations arise (14, 18). As for the in-hospital time, the only relationship that is established as a factor contributing for a shorter in-hospital time was with the activation of fast tracks, without differences between the two hospitals studied. The results indicate that educational campaigns are needed to increase public awareness of the signs of a stroke and that there is also the need to call 112 immediately when people are likely to be having a stroke. These attitudes, despite some differences in outcomes between hospitals, were important to the general population, with the aim to inform the entire community about the risk factors, signs and symptoms, and what to do immediately before a stroke. Similarly, it concluded that doctors and hospitals should be trained for rapid recognition of symptoms and signs, and also to act quickly and as a well-organized team when dealing with a patient suffering from a stroke.
Objective: This study was designed with the aim of determining the factors that lead to patientsâ delayed arrivals at hospitals. To do so two hospital centers in different regions of the country were chosen: one in the interior/center and one in the coastal/ north of the country. Both pre-hospital and intra-hospital factors were evaluated. Methods: 154 patients were surveyed during the period in which the investigation of which were in the inpatient hospital in the hospitals of Cova da Beira and Entre Douro e Vouga. Pre-hospital time was defined as the time from the onset of symptoms to arrival at the hospital. The intra-hospital time was defined as the time from arrival at the hospital until the time the patient was seen by the doctor. Results: the 154 patients that were surveyed were diagnosed with signs or symptoms of acute cerebrovascular accidents. Of those 57.8 % were male and 42.2 % were female. The average age of this population was 73 (73.79) and 52.6% of the patients arrived within 3 hours from the onset of the condition. In this study, 118 patients were over 65 years. Only 20.1% of patients did not show any pathological antecedents of risk for the occurrence of stroke, with the remaining population = 1 risk factor considered in the questionnaire. The most frequent symptom was muscle paresis (64.9%) and 36.4 % of patients called for emergency service (112). Activation of fast tracks occurred in 50 % of cases, and of those, 81.8% arrived on time window for therapy, the 3 hours. The average intra-hospital time was 22 minutes, and the window time was divided into categories, showing the predominance of 11 and 20 minutes for a patient to be seen by a doctor since entering the hospital. A total of 154 patients, 89% were admitted with a diagnosis of ischemic stroke, and the remaining 11% with hemorrhagic stroke. Results: the 154 patients that were surveyed were diagnosed with signs or symptoms of acute cerebrovascular accidents. Of those 57.8% were male and 42.2 % were female. The average age of this population was 73 (73.79) and 52.6% of the patients arrived within 3 hours from the onset of the condition. In this study, 118 patients were over 65 years. Only 20.1% of the patients did not show any pathological antecedents of risk of the occurrence of a stroke, with the remaining population = 1 risk factor considered in the questionnaire. The most frequent symptom was muscle paralysis (64.9%). 36.4 % of the patients called for emergency service (112). Activation of fast tracks occurred in 50 % of cases, and of those, 81.8 % arrived on time window for therapy, the 3 hours. The average intra-hospital time was 22 minutes, and the window time was divided into categories, showing the predominance of 11 to 20 minutes for a patient to be seen by a doctor since entering the hospital. 89% of the 154 patients were admitted with a diagnosis of ischemic stroke, and the remaining 11% with hemorrhagic stroke. Conclusion: Rapid treatment is a determinant factor for a better prognosis of an acute stroke. In this study, 48% of the patients arrived outside the range of the recommended time for medical intervention (= 3 hours). Shorter prehospital times were statistically significantly associated with the presence of symptoms of speech, use of emergency services (112), activation of fast tracks and the highest value of the NIHSS on admission of the patient in the ED. Delay factors such as the occupation of the patient, dyslipidemia and symptoms of vision as manifestations of a stroke were established. Only some showed statistical significance for the given population, including dyslipidemia and manifestations of vision in stroke as factors of delay in arrival at the hospital in CHDV. No relationship with statistical significance between the type of stroke and a shorter hospital arrival was established. It was concluded, that a patient with stroke symptom should call 112 immediately, as there was a statistical significance in both hospitals. Given that only 37% of patients used the INEM when they were faced with a stroke, this is therefore an important point of intervention: to inform the public that the call to 112 is the first action to take when they stroke manifestations arise (14, 18). As for the in-hospital time, the only relationship that is established as a factor contributing for a shorter in-hospital time was with the activation of fast tracks, without differences between the two hospitals studied. The results indicate that educational campaigns are needed to increase public awareness of the signs of a stroke and that there is also the need to call 112 immediately when people are likely to be having a stroke. These attitudes, despite some differences in outcomes between hospitals, were important to the general population, with the aim to inform the entire community about the risk factors, signs and symptoms, and what to do immediately before a stroke. Similarly, it concluded that doctors and hospitals should be trained for rapid recognition of symptoms and signs, and also to act quickly and as a well-organized team when dealing with a patient suffering from a stroke.
Description
Keywords
Acidente Vascular Cerebral Cuidados Organizados Tempo Intra-Hospitalar Tempo Pré-Hospitalar Vias Verdes