Performance measures for in-hospital care of acute ischemic stroke in public hospitals in ChileReport as inadecuate

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Background: The aim of this study were to describe acute care of ischemic stroke patients and adherence toperformance measures, as well as the outcomes of these events, in a sample of patients treated in public hospitalsin Chile.Methods: We retrospectively reviewed the medical charts of patients with ischemic stroke from a sample of sevenpublic hospitals in the Metropolitan Region of Santiago. We analyzed adherence to the following evidence-basedmeasures: clinical evaluation at admission, use of intravenous thrombolysis, dysphagia screening and prescription ofantithrombotic 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, whichaccounted for clustering of patients within hospitals and included sex, age years, clinical status at admissionreduced level of consciousness, speech disturbance, aphasia and hemiplegia, comorbidities, dysphagia screeningand 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 inwomen and 66.3 years in men. Diagnosis of stroke was confirmed by a computed tomography scan within4.5 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% CI6.7-11.3. 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 casefatality and dysphagia screening or neurological evaluation at admission. The factors associated with post-strokepneumonia 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 ofconsciousness on admission OR 3.4, 95% CI 2.1-5.5. No association was found between pneumonia and dysphagiascreening or neurological evaluation at admission.Conclusions: Adherence to evidence-based performance measures was low. Administration of intravenousthrombolysis was particularly low and diagnostic confirmation of ischemic stroke was delayed. The occurrence ofpost-stroke pneumonia was frequent and should be reduced. To improve acute stroke care in Chile, organizationalchange in the health service is urgently needed.Nota general

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Author: Hoffmeister, Lorena; - Lavados Germain, Pablo; - Comas, Merce; - Vidal, Carolina; - Cabello, Rodrigo; - Castells, Xavier; -



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