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      Stroke study group: preliminary results early intensive care improves functional outcome Translated title: Acidente vascular encefálico isquêmico: protocolo para atendimento precoce; redução da mortalidade e morbidade

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          Abstract

          Early and intensive care seems to positively affect outcome in stroke patients. A standardized protocol, costly adjusted to our reality and suitable for application by non-specialist at Emergency Room, proved effective, reflecting in diagnosis reliability, reducing time for beginning therapy, leading to low mortality rates and better functional outcomes at discharge.

          Translated abstract

          Evidências atuais enfatizam a necessidade de tratamento precoce para os acidentes vasculares encefálicos isquêmicos, numa tentativa de reverter o quadro metabólico que se desenvolve nas primeiras horas após sua instalação. Objetivando reduzir custos, aumentar a eficiência das medidas diagnósticas e terapêuticas, além de reduzir o tempo de início do tratamento, um protocolo de ação vem sendo sistematicamente aplicado em nosso Hospital desde setembro-1992. Após seu primeiro ano de uso, com 157 pacientes consecutivos atendidos, houve uma redução na mortalidade imediata e, principalmente, significativa redução na morbidade, com evidente melhora na qualidade de sobrevida de nossos pacientes.

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          Silent aspiration following stroke.

          Steven Massey, Patrick J Horner (1988)
          Neurogenic dysphagia following stroke is not limited to brainstem involvement. Among 21 patients with stroke, one-third demonstrated only unilateral signs. In eight patients with silent aspiration, less subjective complaints, weaker cough, and dysphonia occurred more often. Videofluoroscopy must be used liberally in unilateral and bilateral strokes.
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            Deteriorating ischemic stroke: risk factors and prognosis.

            E Cendra, J Teruel, D Genis … (1990)
            To determine a risk profile of deterioration in cerebral infarction of less than 8 hours' duration, we studied prospectively a series of clinical and radiologic data in 98 patients. We evaluated the Canadian Neurological Scale Score and Barthel index during a follow-up period of 3 months. There was deterioration in the 1st 48 hours in 40.8% of the patients. High systolic blood pressure, elevated blood sugar concentration at admission, and carotid territory involvement were independently related with deterioration in the logistic regression analysis. Death occurred in 35% of the patients with deteriorating infarcts and in 8.6% of those with stable infarcts. At the end of the study, functional capacity was lower in those with deteriorating infarcts, but the 2 groups improved in parallel from the 4th day onward.
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              Benefit of a stroke unit: a randomized controlled trial.

              R Rokseth, F Bakke, B Indredavik … (1991)
              In a randomized controlled trial we compared the clinical outcome of acute stroke patients, 110 of whom were allocated to treatment in a stroke unit and 110 to treatment in general medical wards. No significant difference existed between these groups with regard to sex, age, marital status, medical history, or functional impairment on admission. Outcome was measured at 6 and 52 weeks after the stroke by the proportion of patients at home, the proportion of patients in an institution, the mortality, and the functional state. After 6 weeks 56.4% of the patients randomized to the stroke unit and 32.7% of the patients randomized to the general medical wards were at home (p = 0.0004), and after 52 weeks 62.7% and 44.6%, respectively, were at home (p = 0.002). After 6 weeks 36.3% of the patients from the stroke unit and 50.0% from the general medical wards were in an institution (p = 0.02); after 52 weeks 12.7% and 22.7%, respectively, were institutionalized (p = 0.016). After 6 weeks mortality was 7.3% for the stroke unit group and 17.3% for the general medical wards group (p = 0.027). After 52 weeks mortality was 24.6% for the stroke unit group and 32.7% for the general medical wards group (difference not significant). Functional state was significantly better for patients treated in the stroke unit after both 6 and 52 weeks. We conclude that care of patients with acute stroke in a stroke unit improves clinical outcome compared with treatment in general medical wards.
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                Author and article information

                Journal
                Journal ID (publisher-id): anp
                Title: Arquivos de Neuro-Psiquiatria
                Abbreviated Title: Arq. Neuro-Psiquiatr.
                Publisher: Academia Brasileira de Neurologia - ABNEURO (São Paulo, SP, Brazil )
                ISSN (Print): 0004-282X
                ISSN (Electronic): 1678-4227
                Publication date (Print and electronic): September 1994
                Volume: 52
                Issue: 3
                Pages: 330-338
                Affiliations
                [01] Rio de Janeiro orgnameHospital da Penitência orgdiv1Department of Neurology
                Article
                Publisher ID: S0004-282X1994000300008 Publisher ID: S0004-282X(94)05200308
                DOI: 10.1590/S0004-282X1994000300008
                SO-VID: d246f6dc-ed0d-4ea1-9298-dd16342cf59d
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 9
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                SciELO Brazil


                Keywords: acidente vascular encefálico isquêmico,stroke,treatment,functional outcome,mortality,tratamento,morbidade,mortalidade
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                Keywords: acidente vascular encefálico isquêmico, stroke, treatment, functional outcome, mortality, tratamento, morbidade, mortalidade

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