Epidemiological analysis of stroke patients with emphasis on access to acute-phase therapies

ABSTRACT Background: Stroke is a public health problem. For patients with ischemic stroke, venous thrombolysis and mechanical thrombectomy are effective therapeutic options. However, even after the National Stroke Treatment Guidelines were published in 2012, the number of cases treated is still lower than expected. Objective: To identify the determining factors for obtaining access to acute-phase therapies in the state of Espírito Santo (ES) and investigate the profile of stroke patients treated at the Central State Hospital (HEC). Methods: Retrospective data from the medical records of 1078 patients from May 2018 to December 2019 were analyzed. Results: Among the 1,078 patients, 54.9% were men and the most prevalent age group was 60 to 79 years. Systemic arterial hypertension was the main single risk factor. Regarding treatment modality among the patients who arrived at the HEC within the therapeutic window, 47% received some type of acute-phase therapy. Waking up with the deficit was the main contraindication for venous thrombolysis in these cases. Conclusions: Application of the flowchart established by SESA-ES seemed to be effective for enabling responsiveness of care for stroke victims. Public emergency transport services had a fundamental role in this process. In addition, the care provided by the tertiary stroke center provided excellent access to acute-phase therapies. However, despite the efficiency of the service provided at the HEC, it only reached a maximum of 50% of the ES population. This service model therefore needs to be expanded throughout the state.

摘要 研究背景：脑卒中（Stroke）是一类公共卫生问题。对于缺血性脑卒中患者，静脉溶栓（venous thrombolysis）与机械取栓（mechanical thrombectomy）均为有效的治疗手段。即便2012年《国家脑卒中治疗指南》正式发布，接受治疗的病例数仍未达预期。研究目的：明确巴西圣埃斯皮里图州（Espírito Santo，简称ES）脑卒中患者获得急性期治疗的决定因素，并调查该州中央医院（Central State Hospital，简称HEC）收治的脑卒中患者的诊疗特征。研究方法：回顾性分析2018年5月至2019年12月期间1078例患者的病历资料。研究结果：1078例患者中，54.9%为男性，最常见的年龄区间为60~79岁；系统性动脉高血压为最主要的单一危险因素。在治疗时间窗内抵达HEC的患者中，47%接受了至少一种急性期治疗方案；此类患者中，晨起出现神经功能缺损是静脉溶栓的主要禁忌证。研究结论：圣埃斯皮里图州卫生厅（SESA-ES）制定的诊疗流程图在提升脑卒中患者救治响应效率方面效果显著。公共应急转运服务在该流程中发挥了核心作用。此外，该三级脑卒中中心提供的诊疗服务可使患者获得良好的急性期治疗可及性。不过，尽管HEC的诊疗服务效率可观，其服务覆盖范围仅达到ES州总人口的50%上限，因此该服务模式需在全州范围内推广。