Acute Stroke in northern Portugal: outcomes and characteristics of patients in a Medical-Surgical Emergency Department
DOI:
https://doi.org/10.29352/mill0226.36532Keywords:
Stroke; Emergency Service; health care; Acute Stroke Treatment Protocol; quality of health careAbstract
Introduction: Stroke is a leading cause of morbidity and long-term disability worldwide, significantly impacting health systems and personal lives. Disparities in European access to stroke care suggest an increased burden on individuals and society. Effective management of acute stroke in emergency departments is critical, requiring a rapid and coordinated response to optimize clinical outcomes.
Objective: Characterize the hospital approach to acute stroke patients attended through the Stroke Pathway (Via Verde AVC) protocol in a Medical-Surgical Emergency Department in northern Portugal.
Methods: Retrospective observational study of 1153 patients admitted through the Acute Stroke Care Pathway from 2019 to 2023. Data on patient demographics, clinical characteristics, treatments, and outcomes were collected from electronic medical records. Statistical analysis included chi-square tests, ANOVA, Kruskal-Wallis tests, trend analysis, and logistic regression.
Results: Stroke Pathway activations increased from 0.28% in 2019 to 0.31% in 2023 (p<0.05). Ischemic stroke was most common (64.8%, 95% CI: 62.1-67.4%). Thrombolysis rates increased from 21.96% to 27.27% (p<0.01), and thrombectomy from 4.67% to 21.21% (p<0.001). Age >70 years (OR 1.8, 95% CI: 1.3-2.5) and arrival within 3 hours (OR 2.3, 95% CI: 1.7-3.1) predicted reperfusion therapy. Female patients surpassed males in 2023 (51.01% vs 48.99%).
Conclusion: The Emergency Department demonstrated improvement in acute stroke care. Enhanced systematic data recording and new technologies are needed to optimize care. Future research should focus on long-term outcomes and quality-of-life measures.
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Aguiar de Sousa, D., Wilkie, A., Norrving, B., Macey, C., Bassetti, C., Tiu, C., Roth, G., Lunde, G., Christensen, H., Fiehler, J., Pezzella, F. R., Dichgans, M., Roaldsen, M. B., Kelly, P., Mikulik, R., Sacco, S., Caso, V., Fischer, U., Basha, E., … Droste, D. (2023). Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020. European Stroke Journal, 8(3), 618–628. https://doi.org/10.1177/23969873231186042
Ahmed, N., Audebert, H., Turc, G., Cordonnier, C., Christensen, H., Sacco, S., Sandset, E. C., Ntaios, G., Charidimou, A., Toni, D., Pristipino, C., Köhrmann, M., Kuramatsu, J. B., Thomalla, G., Mikulik, R., Ford, G. A., Martí-Fàbregas, J., Fischer, U., Thoren, M., … Steiner, T. (2019). Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018. European Stroke Journal, 4(4), 307–317. https://doi.org/10.1177/2396987319863606
American Stroke Association. (2023). Types of Stroke and Treatment. https://www.stroke.org/en/about-stroke/types-of-stroke
Berge, E., Whiteley, W., Audebert, H., De Marchis, G., Fonseca, A. C., Padiglioni, C., Pérez de la Ossa, N., Strbian, D., Tsivgoulis, G., & Turc, G. (2021). European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. European Stroke Journal, 6(1), I–LXII. https://doi.org/10.1177/2396987321989865Direção Geral de Saúde. (2017). Norma nº 015/2017: Via Verde do Acidente Vascular Cerebral no Adulto. https://normas.dgs.min-saude.pt/2017/07/13/via-verde-do-acidente-vascular-cerebral-no-adulto/
European Stroke Organisation. (2024). ESO and SAFE commemorate European Stroke Awareness Day 14 May 2024. https://actionplan.eso-stroke.org/new-sap-e-data-release-on-european-stroke-awareness-day-2024
Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., Abbasifard, M., Abbasi-Kangevari, M., Abd-Allah, F., Abedi, V., Abualhasan, A., Abu-Rmeileh, N. M., Abushouk, A. I., Adebayo, O. M., Agarwal, G., Agasthi, P., Ahinkorah, B. O., Ahmad, S., Ahmadi, S., … Murray, C. J. L. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
Qiu, S., & Xu, Y. (2020). Guidelines for Acute Ischemic Stroke Treatment. Neuroscience Bulletin, 36(10), 1229–1232. https://doi.org/10.1007/s12264-020-00534-2
Heran, M., Lindsay, P., Gubitz, G., Yu, A., Ganesh, A., Lund, R., Arsenault, S., Bickford, D., Derbyshire, D., Doucette, S., Ghrooda, E., Harris, D., Kanya-Forstner, N., Kaplovitch, E., Liederman, Z., Martiniuk, S., McClelland, M., Milot, G., Minuk, J., … Shamy, M. (2024). Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7th Edition Practice Guidelines Update, 2022. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 51(1), 1–31. https://doi.org/10.1017/cjn.2022.344
Insituto Nacional de Estatística (2022). Em 2022, aumentaram principalmente as mortes por doenças do aparelho respiratório. https://www.ine.pt/xportal/xmain?DESTAQUESdest_boui=646029525&DESTAQUESmodo=2&xpgid=ine_destaques&xpid=INE
Jadhav, A. P., Desai, S. M., & Jovin, T. G. (2021). Indications for Mechanical Thrombectomy for Acute Ischemic Stroke. Neurology, 97(20_Supplement_2), S126–S136. https://doi.org/10.1212/WNL.0000000000012801
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Turan, T. N., & Williams, L. S. (2021). 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke, 52(7), e364–e467. https://doi.org/10.1161/STR.0000000000000375
Marshall, I., McKevitt, C., Wang, Y., Wafa, H., Skolarus, L., Bhalla, A., Muruet-Gutierrez, W., Emmett, E., Sommerville, P., Birns, J., Sackley, C., Clarke, S., Hamidi, F., Stevens, E., Rudd, A. G., Rodgers, H., & Wolfe, C. D. A. (2022). Stroke pathway—An evidence base for commissioning—An evidence review for NHS England and NHS Improvement. NIHR Open Research, 2, 43. https://doi.org/10.3310/nihropenres.13257.1
Mokin, M., Ansari, S. A., McTaggart, R. A., Bulsara, K. R., Goyal, M., Chen, M., & Fraser, J. F. (2019). Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): Report of the SNIS Standards and Guidelines Committee. Journal of NeuroInterventional Surgery, 11(3), 215–220. https://doi.org/10.1136/neurintsurg-2018-014640
Monteiro, S., Bem, O., & Ribeiro, L. (2020). Funcionamento da Via Verde AVC Isquémico em Fase Hiperaguda. Unidade Local de saúde Matosinhos, E.P.E. Protocolo nº 1075.2 de 16/11/2020.
Moutinho, M., Magalhães, R., Correia, M., & Silva, C. (2013). Avaliação da Via Verde do Acidente Vascular Cerebral no Norte de Portugal: Caracterização e Prognóstico dos Utilizadores. https://repositorio.chporto.pt/entities/publication/1be2a61d-3e48-433f-9363-6fc1217b2ebe/full
Norrving, B., Barrick, J., Davalos, A., Dichgans, M., Cordonnier, C., Guekht, A., Kutluk, K., Mikulik, R., Wardlaw, J., Richard, E., Nabavi, D., Molina, C., Bath, P. M., Stibrant Sunnerhagen, K., Rudd, A., Drummond, A., Planas, A., & Caso, V. (2018). Action Plan for Stroke in Europe 2018–2030. European Stroke Journal, 3(4), 309–336. https://doi.org/10.1177/2396987318808719
Qiu, S., & Xu, Y. (2020). Guidelines for Acute Ischemic Stroke Treatment. Neuroscience Bulletin, 36(10), 1229–1232. https://doi.org/10.1007/s12264-020-00534-2
Silva, S., & Gouveia, M. (2012). Program “Via verde do AVC”: Analysis of the impact on stroke mortality. Revista Portuguesa de Saúde Pública, 30(2), 172–179. https://doi.org/10.1016/j.rpsp.2012.12.005
Serviço Nacional de Saúde. (2019). Dia Mundial do AVC. https://www.sns.gov.pt/noticias/2019/10/28/dia-mundial-do-avc-3/
Sociedade Portuguesa de Medicina Interna. (2021). O AVC é a principal causa de morte e incapacidade em Portugal. https://www.spmi.pt/o-avc-e-a-principal-causa-de-morte-e-incapacidade-em-portugal/
Turc, G., Bhogal, P., Fischer, U., Khatri, P., Lobotesis, K., Mazighi, M., Schellinger, P. D., Toni, D., Vries, J. de, White, P., & Fiehler, J. (2023). European Stroke Organisation (ESO)—European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke. Journal of NeuroInterventional Surgery, 15(8), e8–e8. https://doi.org/10.1136/neurintsurg-2018-014569
World Health Organization. (2020). Manual de Políticas e Estratégias para a Qualidade dos Cuidados de Saúde: Uma abordagem prática para formular políticas e estratégias destinadas a melhorar a qualidade dos cuidados de saúde. World Health Organization. https://iris.who.int/bitstream/handle/10665/272357/9789240005709-por.pdf
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