Performance measures for in-hospital care of acute ischemic stroke in public hospitals in Chile
Date
2013
Type:
Artículo
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10
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ORCID:
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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Abstract
Background: The aim of this study were to describe acute care of ischemic stroke patients and adherence to
performance measures, as well as the outcomes of these events, in a sample of patients treated in public hospitals
in Chile.
Methods: We retrospectively reviewed the medical charts of patients with ischemic stroke from a sample of seven
public hospitals in the Metropolitan Region of Santiago. We analyzed adherence to the following evidence-based
measures: clinical evaluation at admission, use of intravenous thrombolysis, dysphagia screening and prescription of
antithrombotic therapy at discharge. As outcome measures we analyzed post-stroke pneumonia and 30-day casefatality.
We used a logistic regression model by each outcome with generalized estimating equations, which
accounted for clustering of patients within hospitals and included sex, age (years), clinical status at admission
(reduced level of consciousness, speech disturbance, aphasia and hemiplegia), comorbidities, dysphagia screening
and neurological evaluation at admission as measures of acute stroke care.
Results: We reviewed the charts of 677 patients, of which 52.3% were men. The mean age was 69.8 years in
women and 66.3 years in men. Diagnosis of stroke was confirmed by a computed tomography scan within
4.5 hours of symptom onset in only 9.6% of the patients. Intravenous thrombolysis was administered in 1.7%.
Dysphagia screening was performed in 12.1% (95% CI 9.7-15.0) and antithrombotic therapy was prescribed in 68.9%
(95% CI 64.6-72.9). Pneumonia was diagnosed in 23.6% (95% CI 20.4-27.2). Thirty-day fatality was 8.7% (95% CI
6.7-11.3). The variables independently associated with 30-day case fatality were age (OR 1.08, 95% 1.06-1.10),
pneumonia (OR 7.7, 95% 95% CI 4.0-14.7), aphasia (OR 2.4, 95% CI 1.1-5.6), reduced level of consciousness (OR 2.4,
95% CI 1.3-4.4), and speech disturbance (OR 1.4, 95% CI 1.0-1.9). No association was found between 30-day case
fatality and dysphagia screening or neurological evaluation at admission. The factors associated with post-stroke
pneumonia were female sex (OR 1.6, 95% CI 1.0-2.3), age (OR 1.04 95% CI 1.03-1.05), diagnosis of diabetes (OR 1.8,
95% CI 1.4-2.4), aphasia (OR 2.0, 95% CI 1.5-2.7), hemiplegia (OR 1.6, 95% CI 1.1-2.4), and reduced level of
consciousness on admission (OR 3.4, 95% CI 2.1-5.5). No association was found between pneumonia and dysphagia
screening or neurological evaluation at admission.
Conclusions: Adherence to evidence-based performance measures was low. Administration of intravenous
thrombolysis was particularly low and diagnostic confirmation of ischemic stroke was delayed. The occurrence of
post-stroke pneumonia was frequent and should be reduced. To improve acute stroke care in Chile, organizational
change in the health service is urgently needed.
Description
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Citation
BMC Neurology, 2013, 13:23
Keywords
Acute ischemic stroke, Stroke care, Thrombolysis