Figura. Diagrama de flujo.
Tabla I. Análisis de los tiempos de asistencia inicio-puerta (TPH) y puerta-tomografía computarizada (TPI) en relación con los factores demográficos, factores de riesgo, tratamientos y procedencia del paciente en la cadena asistencial. Tiempos en horas:minutos. |
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TPH Mediana (p25-p75) |
TPI Mediana (p25-p75) |
||
Total |
04:34 (02:01-11:25) |
00:38 (00:20-01:10) |
|
Sexo |
Masculino Femenino |
04:30 (01:56-11:15) 05:02 (02:16-14:03) |
00:40 (00:20-01:11) 00:36 (00:19-01:10) |
Edad |
≥ 80 años < 80 años |
06:00 (02:02-11:17) 04:29 (01:59-12:06) |
00:38 (00:19-01:11) 00:39 (00:20-01:10) |
Factores de riesgo |
Hipertensión (–) |
05:38 (02:05-12:50) 03:50 (01:52-10:30) |
00:39 (00:21-01:10) 00:38 (00:17-01:11) |
Dislipidemia (–) |
06:00 (02:20-12:40) 04:07 (01:51-11:15) |
00:40 (0020-01:13) 00:36 (00:18-01:05) |
|
Fumador (–) |
03:31 (01:45-10:50) 05:30 (02:14-12:25) |
00:37 (00:15-01:14) 00:38 (00:23-01:08) |
|
Diabetes (–) |
04:14 (02:31-11:40) 04:44 (01:46-11:27) |
00:43 (00:29-01:24) 00:36 (00:18-01:09) |
|
Cardiopatía isquémica (–) |
04:37 (01:47-10:08) 04:34 (02:01-11:55) |
00:39 (00:15-01:11) 00:38 (00:20-01:10) |
|
Fibrilación auricular (–) |
04:44 (01:54-13:15) 04:30 (02 e:01-11:15) |
00:40 (00:14-01:24) 00:38 (00:20-01:07) |
|
Ictus previo (–) |
02:30 (01:45-10:25) 04:52 (02:04-12:37) |
00:37 (00:31-01:05) 00:39 (00:19-01:11) |
|
Tratamiento |
Antitrombótico a (–) |
04:05 (01:52-10.30) 05:02 (02:05-13:04) |
00:34 (00:15-01:08) 00:40 (00:22-01:12) |
Estatina (–) |
05:40 (02:09-13:22) 04:22 (01:57-10:59) |
00:43 (00:20-01:17) 00:36 (00:18-00:59) |
|
Hipotensor (–) |
06:10 (02:20-13:45) 03:29 (01:48-10:17) b |
00:39 (00:20-01:10) 00:37 (00:18-01:10) |
|
NIHSS al ingreso |
≥ 4 < 4 |
03:49 (01:50-10:23) c |
00:35 (00:18-01:05) 00:44 (00:23-01:13) |
Procedencia de la cadena asistencial |
Atención primaria Emergencias Urgencias de otro centro |
05:35 (02:10-12:53) 03:20 (01:30-08:57) d 06:05 (02:30-15:20) |
00:45 (00:29-01:16) 00:24 (00:14-00:47) e 00:33 (00:15-01:10) |
(–): ausencia del factor; NIHSS: National Institute of Heath Stroke Scale. a Uso de anticoagulantes o antiagregantes; b p = 0,016; c p = 0,031; d p = 0,034; e p < 0,001. |
Tabla II. Análisis de los tiempos de asistencia inicio-puerta (TPH) y puerta-tomografía computarizada (TPI) en relación con los datos clínicos. Tiempos en horas:minutos. |
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Tiempo de casos con clínica (TPH) Mediana (p25-p75) |
Tiempo de casos sin clínica (TPH) Mediana (p25-p75) |
Tiempo de casos con clínica (TPI) Mediana (p25-p75) |
Tiempo de casos sin clínica (TPI) Mediana (p25-p75) |
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Manifestación clínica |
Déficit visual/hemianopsia |
05:00 (02:05-13:46) |
04:30 (01:57-11:10) |
00:42 (00:20-01:04) |
00:38 (00:19-01:09) |
Diplopía |
04:30 (02:01-10:29) |
04:44 (02:00-12:23) |
00:34 (00:20-00:58) |
00:40 (00:20-01:11) |
|
Disartria |
03:04 (01:30-10:29) c |
06:09 (02:30-14:00) |
00:35 (00:15-00:53) f |
00:45 (00:27-01:13) |
|
Mareo/vértigo |
05:20(01:49-14:00) |
04:32 (02:03-10:51) |
00:36 (00:21-00:56) |
00:38 (00:20-01:10) |
|
Ataxia |
05:36 (02:24-15:36) |
03:48 (01:53-10:37) d |
00:38 (00:21-01:05) |
00:39 (00:18-01:11) |
|
Pérdida de fuerza |
03:34 (01:41-09:44) e |
05:40 (02:08-13:18) |
00:33 (00:14-00:55) g |
00:43 (00:23-01:14) |
|
Pérdida de sensibilidad |
05:10 (02:09-11:02) |
04:30 (02:00-11:55) |
00:35(00:18-01:06) |
00:39 (00:22-01:12) |
|
Cefalea |
09:37 (03:36-18:15) |
04:14 (01:55-10:44) |
00:43 (00:29-01:25) |
00:38 (00:17-01:10) |
|
Náuseas/vómitos |
05:39 (02:24-14:15) |
04:30 (02:00-11:01) |
00:43 (00:15-01:09) |
00:38 (00:23-01:10) |
|
Signo/síndrome |
Alteración oculomotora supranuclear |
03:35(01:34-06:46) |
04:52 (02:00-12:08) |
00:34 (00:13-01:12) |
00:39 (00:20-01:10) |
Afectación de los pares craneales |
05:49 (02:04-11:01) |
04:14 (01:59-12:59) |
00:35 (00:17-01:10) |
00:40 (00:21-01:10) |
|
Nistagmo |
05:49 (02:13-15:08) |
04:14 (02:00-10:59) |
00:44 (00:16-01:12) |
00:37 (00:20-01:08) |
|
Síndrome cerebeloso |
05:25 (02:03-11:09) |
04:14 (02:00-13:06) |
00:40 (00:22-01:11) |
00:36 (00:17-01:09) |
|
> 1 dato clínico a |
> 1 |
< 1 |
> 1 |
< 1 |
|
04:29 (01:58-10:24) |
06:14 (02:21-14:07) |
00:36 (00:16-01:02) h |
00:46 (00:25-01:25) |
||
Oclusión arterial |
Sí |
No |
Sí |
No |
|
Cualquier vaso b |
08:48 (02:30-19:18) |
04:30 (01:54-11:00) i |
00:32 (00:17-00:56) |
00:40 (00:20-01:12) |
|
Basilar |
10:25 (01:48-20:45) |
04:30 (02:00-11:15) |
00:25 (00:10-01:19) |
00:39 (00:20-01:10) |
|
a Observación de más de una manifestación clínica o más de un signo; b Vertebral, basilar, cerebral posterior; c p = 0,002; d p = 0,037; e p = 0,043; f p = 0,003; g p = 0,003; h p = 0,010; i p = 0,041. |
Tabla III. Factores relacionados con la activación del código ictus. Análisis univariante y multivariante. |
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Activación |
No activación |
p |
Odds ratio |
p |
||
Factores demográficos |
Edad media (años) |
67,31 ± 12,88 |
70,32 ± 12,47 |
0,140 |
||
Sexo masculino |
32 (66,7%) |
119 (64,3%) |
0,894 |
|||
≥ 80 años |
6 (12,5%) |
47 (25,4%) |
0,057 |
|||
Factores de riesgo |
Hipertensión |
26 (54,2%) |
122 (65,9%) |
0,179 |
||
Dislipidemia |
17 (35,4%) |
88 (47,6%) |
0,179 |
|||
Fumador |
27 (56,3%) |
69 (37,3%) |
0,017 |
2,37 (1,18-4,79) |
0,015 |
|
Diabetes |
7 (14,6%) |
46 (24,9%) |
0,187 |
|||
Cardiopatía isquémica |
3 (6,3%) |
17 (9,2%) |
0,773 |
|||
Fibrilación auricular |
11 (22,9%) |
39 (21%) |
0,783 |
|||
Ictus previo |
2 (4,2%) |
21 (11,4%) |
0,179 |
|||
Tratamiento |
Antitrombótico |
19 (39,6%) |
62 (33,5%) |
0,431 |
||
Estatina |
16 (33,3%) |
77 (41,6%) |
0,296 |
|||
Hipotensor |
20 (41,3%) |
103 (55,7%) |
0,083 |
|||
NIHSS al ingreso |
Mediana (p50-p75) |
6 (4,10) |
4 (2,6) |
< 0,001 |
||
≥ 4 puntos |
37 (77,1%) |
106 (57,3%) |
0,012 |
|||
Manifestación clínica |
Déficit visual/hemianopsia |
9 (18,8%) |
47 (25,4%) |
0,223 |
||
Diplopía |
12 (25%) |
31 (16,8%) |
0,136 |
|||
Disartria |
35 (72,9%) |
72 (38,9%) |
< 0,001 |
2,93 (1,39-6,19) |
0,005 |
|
Mareo |
17 (35,4%) |
72 (38,9%) |
0,781 |
|||
Ataxia |
14 (29,2%) |
73 (39,5%) |
0,252 |
|||
Pérdida de fuerza |
28 (58,3%) |
52 (28,1%) |
< 0,001 |
2,56 (1,25-5,22) |
0,010 |
|
Pérdida de sensibilidad |
18 (37,5%) |
62 (33,5%) |
0,728 |
|||
Vértigo |
1 (2,1%) |
13 (7%) |
0,175 |
|||
Cefalea |
2 (4,2%) |
26 (14,1%) |
0,079 |
|||
Náuseas/vómitos |
14 (29,2%) |
41 (22,2%) |
0,408 |
|||
Disfagia |
1 (2,1%) |
3 (1,6%) |
1,000 |
|||
Signo/síndrome |
Alteración oculomotora supranuclear |
4 (8,3%) |
5 (2,7%) |
0,09 |
||
Afectación de los pares craneales |
25 (52,1%) |
61 (33%) |
0,014 |
|||
Nistagmo |
12 (25%) |
52 (28%) |
0,804 |
|||
Síndrome cerebeloso |
20 (41,7%) |
86 (46,5%) |
0,664 |
|||
Manifestaciones clínicas |
>1 dato clínico |
44 (91,7%) |
121 (65,4%) |
< 0,001 |
3,21 (1,02-10,06) |
0,045 |
> 1 signo clínico |
19 (39,6%) |
92 (49,7%) |
0,257 |
|||
Oclusión arterial |
Cualquier vaso |
11 (23,9%) |
35 (76,1%) |
0,670 |
||
IC 95%: intervalo de confianza al 95%; NIHSS: National Institute of Heath Stroke Scale. |
Vertebrobasilar stroke: recording of care times and factors related to early care Aim. To determine the state of the vertebrobasilar stroke care chain in our hospital reference area by evaluating the factors related to stroke code activation and management times. Patients and methods. Observational, analytical and retrospective study, carried out during the period 2017-2018, which includes patients admitted with a diagnosis of stroke confirmed by neuroimaging. Data were collected consecutively during assessment in the emergency department and admission to the stroke unit. Clinical factors, neurological signs and symptoms at the time of admission, detection of large-vessel occlusion and variables related to the care chain were evaluated, namely, basic medical attention, stroke code activation, onset-to-door time and door-to-imaging time. Results. Altogether 954 patients were included in the study, 233 with vertebrobasilar stroke. The onset-to-door and door-to-imaging times registered were significantly higher for posterior circulation stroke. The factors related to a lower delay in onset-to-door time were: National Institutes of Health Stroke Scale > 4, dysarthria and loss of strength. A shorter delay in door-to-imaging time was observed for the variables basic attention by medical emergency service, dysarthria, loss of strength and presence of more than one symptom/sign. Predictive variables for stroke code activation were a history of smoking, clinical signs of dysarthria or loss of strength, and the presence of more than one clinical manifestation. Conclusions. In the pre-hospital phase is is difficult to identify vertebrobasilar stroke, which causes delays in care times. Training in knowledge of the clinical features of vertebrobasilar stroke could allow these times to be optimised. Key words. Acute stroke. Care times. Healthcare emergencies. Neurological emergencies. Stroke code. Vertebrobasilar ischaemia. |