Dados do Trabalho

Título

Epidemiological and clinical indicators of a type III emergency care center for stroke in Juiz de Fora (Minas Gerais)

Resumo

Introduction: Stroke is one of the leading causes of morbidity and mortality in Brazil and in the world. Thrombolytic therapy and stroke units were important advances to patients suffering from stroke. The Stroke Unit of the reference stroke center in Juiz de Fora has a multidisciplinary team to assist stroke patients 24 hours a day, and it serves the entire macro-region of Juiz de Fora, in Minas Gerais state, exclusively within the scope of “Sistema Unico de Saúde” (SUS). Objective: To study epidemiological and clinical indicators of a stroke care center in Juiz de Fora (Minas Gerais), Brazil. Method: Medical records of patients admitted to the emergency department and referred to the hospital from September 2020 to March 2022 were retrospectively reviewed. Results: A total of 732 individuals (371 [50.8%] male, mean age 67 years) with a predictive diagnosis of stroke were referred to the hospital from September 2020 to March 2022 and their medical charts were reviewed. With regards to the comorbidities, 560 (76.6%) had arterial hypertension and 212 (29.0%) were diabetics. Regarding lifestyle habits, 385 (52.7%) patients were smokers and 428 (58.5%) were alcohol consumers. Mean symptom onset occurred 691 minutes (11.5 hours) before admission. Mean NIHSS score value was 8.0 points. Thrombolysis was performed in only 57 (7.9%) of patients. Cranial CT scans were normal in 264 (36.2%) of patients. 423 (57.8%) scans showed ischemic stroke while 45 (6%) showed hemorrhagic stroke. The average time the patients stayed in the hospital was 11 days. At discharge, the average NIHSS was 4.0 points and the mean RANKIN scale score was 3.0 points. 543 (74.2%) were discharged with platelet antiaggregation, 633 (86.5%) with statin prescription. Among hospitalized patients, 610 (83.4%), received deep vein thrombosis prophylaxis in the first 48hrs. At hospital discharge, 579 (79.1%) patients received prescription of a prophylactic and rehabilitation therapy plan. The total mortality rate in 10 months of the study period was 71 (9.7%) and the mean number of deaths was 7.1 deaths, ranging from 4 (0.55%) deaths in September 2021 to 10 (1.36%) deaths in July 2021. Conclusion: Thrombolysis eligibility rate was rather similar to other stroke reference centers in Brazil. We also observed a long time between the onset of symptoms and arrival at the service, which was the main barrier to performing thrombolysis, due to loss of the therapeutic window.