Dados do Trabalho

Título

EIGHT YEARS OF EXPERIENCE WITH STROKE PROTOCOL IN A HOSPITAL IN THE COUNTRYSIDE OF MINAS GERAIS

Resumo

Introduction: Stroke is the second most frequent cause of death in Brazil, and the main cause of disability. The use of care protocol guides the development of best practices in health work processes, and can directly impact the indicators related to stroke. Objective: To express data and evaluate the evolution of quality indicators related to stroke over 8 years after the adoption of care protocols by a hospital in the countryside of Minas Gerais, which serves approximately 400,000 inhabitants. Method: Descriptive, cross-sectional, documentary study that used secondary data collected from the medical records of patients diagnosed with stroke during the years 2014 and 2021. Results: In the analysis, the chi-square test was used, at the nominal level of 5% of significance, which indicated a significant difference in all data presented. In 8 years, 2,608 cases of stroke were managed, of which 2,083 (79.87%) were of ischemic type and 525 (20.13%) were hemorrhagic; of the ischemic strokes, 142 were thrombolysed and another 165 were admitted in a timely manner for thrombolysis, but this was not performed due to contraindications to the use of thrombolytics or failure in care. The number of thrombolysis performed in this period of time were, respectively: 4, 18, 15, 23, 13, 18, 24, and 27. Of the patients who arrived at the hospital less than 4.5 hours after the onset of symptoms, the percentage that had cranial computerized tomography (CCT) performed in less than 25 minutes between 2018 and 2021 were, respectively: 55.9, 69.4, 62.2, and 76.9. Of all the stroke cases, 601 (23.04%) evolved to in-hospital death, the others were discharged. Stroke mortality rates between 2014 and 2021 in percentages were, respectively: 23.4, 24.4, 23.5, 18.9, 21.5, 21.4, 26.0, and 24.2. Conclusion: The adoption of the protocol makes it possible to observe progress in quality of service indicators, such as CCT execution time and number of thrombolysis performed. There is also a progressive drop in mortality between 2014 and 2019, but this rise again, reaching peaks in the years of the Covid-19 pandemic, probably mortality increased in this period due to the absence of 1st and 2nd prevention, which made strokes more frequent and more severe during this period. Therefore, it is stated that the use of protocols organizes the service and directly impacts stroke mortality. Remembering that the real improvement in the indicators comes in health policies in all areas of health.

Palavras Chave

Stroke, Protocol, Mortality