Stroke study group: preliminary results early intensive care improves functional outcome

Figueira, Fernando Faria Andrade

doi:10.1590/S0004-282X1994000300008

Abstracts

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.

stroke; treatment; functional outcome; mortality

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.

acidente vascular encefálico isquêmico; tratamento; morbidade; mortalidade

Stroke study group: preliminary results early intensive care improves functional outcome

Acidente vascular encefálico isquêmico: protocolo para atendimento precoce; redução da mortalidade e morbidade

Fernando Faria Andrade Figueira

M.D., Department of Neurology, Hospital da Penitência, Rio de Janeiro

SUMMARY

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.

Key words: stroke, treatment, functional outcome, mortality.

RESUMO

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.

Palavras chave: acidente vascular encefálico isquêmico, tratamento, morbidade, mortalidade.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgements - I wish to extend my gratitude to all members of study group, whose active participation rendered possible this paper; to my son, Rafael, for his technical assistance and patience; and to Dr. Vladimir Hashinski M.D., for his inestimable comments on our protocol and, above all, for his inspiration.

Aceite: 17-dezembro-1993.

Dr. Fernando Faria de Andrade Figueira - Departamento de Neurologia, Hospital da Penitência - Rua Conde de Bonfim 1033 - 20530-160 Rio de Janeiro RJ - Brasil.

1. Bamford J. Clinical examination in diagnosis and subclassification of stroke. Lancetl992, 339: 400-402.
2. Biller J. Medical management of acute cerebral ischemia. Neurol Clin 1992, 10: 63-85.
3. Bonita R, Stewart A, Beaglehole R. International trends in stroke mortality: 1970-1985. Stroke 1990, 21: 989-992.
4. Bredt DS, Snyder SH. Nitric oxide: a novel neuronal messenger. Neuron 1992, 8: 8-11.
5. Brott T, Reed RL. Intensive care for acute stroke in the community hospital setting: the first 24 hours. Curr Conce of Cerebrovasc Dis Stroke 1989, 24: 1-5.
6. Buchan A. Advances in cerebral ischemia: experimental approaches. Neurol Clin 1992, 10: 49-61.
7. Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian neurological scale: a preliminary study in acute stroke. Stroke 1986, 17: 731-737.
8. Davalos A, Cendra E, Teruel J, Martinez M, Genis D. Deteriorating ischemic stroke: risk factors and prognosis. Neurology 1990, 40:1865-1869.
9. Dennis M, Bamford J, Sandercock P, Molyneux A, Warlow C. Computed tomography in patients with transient ischemic attacks: when a transient ischemic attack is not a transient ischemic attack but a stroke? J Neurol 1990, 237: 257-261.
10. Figueira FFA. Stroke study group: preliminary results. Standardized protocol reduces time-to-start therapy. Rev Bras Med, submitted.
11. Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The stroke data bank: design, methods and baseline characteristics. Stroke 1988, 19: 547-554.
12. Horner J, Massey EW. Silent aspiration following stroke. Neurology 1988, 38: 317-319.
13. Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim LL, Holme I. Benefit of a stroke unit: a randomized controlled trial. Stroke 1991, 22: 1026-1031.
14. Landi G. Clinical diagnosis of transient ischemic attacks. Lancet 1992, 339: 402-405.
15. McCall AL. Perspectives in diabetes: the impact of diabetes on the CNS. Diabetes 1992, 41:557-569.
16. National Institute of Neurological Communicative Disorders and Stroke: Classification of cerebrovascular diseases III. Stroke 1990, 21: 637-676.
17. Oppenheimer S, Hachinski V. Complications of acute stroke. Lancet 1992, 339: 721-724.
18. Powers WJ. Hemodynamics and metabolism in ischemic cerebrovascular disease. Neurol Clin 1992, 10: 31-48.
19. Pulsinelli W. Pathophysiology of acute ischemic stroke. Lancet 1992, 339: 533-536.
20. Sandercock P, Willems H. Medical treatment of acute ischemic stroke. Lancet 1992, 339: 537-539.
21. Stanimirovic D, Micic D, Spatz M, Mrsulja BB. "Therapeutic window" for multiple drug treatment in experimental cerebral ischemia in gerbils. J Stroke Cerebrovasc Dis 1992, 2 (Suppl. 1):P5.
22. Turpie AGG, Levine MN, Hirsh J, Carter CJ, Jay RM, Powers PJ, Andrew M, Magnani HN, Hull RD, Gent M. Double-blind randomized trial of ORG 10172 low- molecular-weight heparinoid in prevention of deep-vein thrombosis in thrombotic stroke. Lancet 1987, 1: 523-526.
23. Welch KMA, Levine SR, Martin G, Ordidge R, Vande Linde AMQ, Helpern JA. Magnetic resonance spectroscopy in cerebral ischemia. Neurol Clin 1992, 10: 1-29.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Sept 1994

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

[1] 1. Bamford J. Clinical examination in diagnosis and subclassification of stroke. Lancetl992, 339: 400-402.

[2] 2. Biller J. Medical management of acute cerebral ischemia. Neurol Clin 1992, 10: 63-85.

[3] 3. Bonita R, Stewart A, Beaglehole R. International trends in stroke mortality: 1970-1985. Stroke 1990, 21: 989-992.

[4] 4. Bredt DS, Snyder SH. Nitric oxide: a novel neuronal messenger. Neuron 1992, 8: 8-11.

[5] 5. Brott T, Reed RL. Intensive care for acute stroke in the community hospital setting: the first 24 hours. Curr Conce of Cerebrovasc Dis Stroke 1989, 24: 1-5.

[6] 6. Buchan A. Advances in cerebral ischemia: experimental approaches. Neurol Clin 1992, 10: 49-61.

[7] 7. Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian neurological scale: a preliminary study in acute stroke. Stroke 1986, 17: 731-737.

[8] 8. Davalos A, Cendra E, Teruel J, Martinez M, Genis D. Deteriorating ischemic stroke: risk factors and prognosis. Neurology 1990, 40:1865-1869.

[9] 9. Dennis M, Bamford J, Sandercock P, Molyneux A, Warlow C. Computed tomography in patients with transient ischemic attacks: when a transient ischemic attack is not a transient ischemic attack but a stroke? J Neurol 1990, 237: 257-261.

[10] 10. Figueira FFA. Stroke study group: preliminary results. Standardized protocol reduces time-to-start therapy. Rev Bras Med, submitted.

[11] 11. Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The stroke data bank: design, methods and baseline characteristics. Stroke 1988, 19: 547-554.

[12] 12. Horner J, Massey EW. Silent aspiration following stroke. Neurology 1988, 38: 317-319.

[13] 13. Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim LL, Holme I. Benefit of a stroke unit: a randomized controlled trial. Stroke 1991, 22: 1026-1031.

[14] 14. Landi G. Clinical diagnosis of transient ischemic attacks. Lancet 1992, 339: 402-405.

[15] 15. McCall AL. Perspectives in diabetes: the impact of diabetes on the CNS. Diabetes 1992, 41:557-569.

[16] 16. National Institute of Neurological Communicative Disorders and Stroke: Classification of cerebrovascular diseases III. Stroke 1990, 21: 637-676.

[17] 17. Oppenheimer S, Hachinski V. Complications of acute stroke. Lancet 1992, 339: 721-724.

[18] 18. Powers WJ. Hemodynamics and metabolism in ischemic cerebrovascular disease. Neurol Clin 1992, 10: 31-48.

[19] 19. Pulsinelli W. Pathophysiology of acute ischemic stroke. Lancet 1992, 339: 533-536.

[20] 20. Sandercock P, Willems H. Medical treatment of acute ischemic stroke. Lancet 1992, 339: 537-539.

[21] 21. Stanimirovic D, Micic D, Spatz M, Mrsulja BB. "Therapeutic window" for multiple drug treatment in experimental cerebral ischemia in gerbils. J Stroke Cerebrovasc Dis 1992, 2 (Suppl. 1):P5.

[22] 22. Turpie AGG, Levine MN, Hirsh J, Carter CJ, Jay RM, Powers PJ, Andrew M, Magnani HN, Hull RD, Gent M. Double-blind randomized trial of ORG 10172 low- molecular-weight heparinoid in prevention of deep-vein thrombosis in thrombotic stroke. Lancet 1987, 1: 523-526.

[23] 23. Welch KMA, Levine SR, Martin G, Ordidge R, Vande Linde AMQ, Helpern JA. Magnetic resonance spectroscopy in cerebral ischemia. Neurol Clin 1992, 10: 1-29.