Medical Complications at a Stroke Unit (SU) of a Tertiary Center in Brazil

Background: Stroke is the second leading cause of death in Brazil. All stroke patients should receive care at a SU in accordance with the guidelines of the American Heart Association (AHA)/American Stroke Association (ASA) - Class of recommendation I. Our institution is provided with a SU since 2019. Objective: To describe the rate of medical complications at our SU. Design and setting: This is a longitudinal descriptive study settled at the ICHCFMUSP. Methods: The incidence of complications during hospitalization at the UAVC was prospectively recorded. The rates of pneumonia, pressure ulcer, urinary tract infection (UTI), and venous thromboembolism (VTE) were analyzed. The period analyzed was from january/2019 to december/2020. Results: 379 patients were admitted at our SU. 50 patients (13.1%) presented at least one complication. 35 patients had only 1 complication, 13 patients had 2 complications, 1 patient had 3 complications and 1 patient had 4 complications. The most frequent complication was UTIs (7.9%), followed by pneumonia (5%), pressure ulcer (2.3%) and VTE (2.3%). 4 patients died during hospitalization at the SU. Conclusion: The rate of complications in our SU is low according to the literature.

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Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States

Stroke ◽

10.1161/strokeaha.120.031144 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3310-3319 ◽

Cited By ~ 2

Author(s):

Esmee Venema ◽

James F. Burke ◽

Bob Roozenbeek ◽

Jason Nelson ◽

Hester F. Lingsma ◽

...

Keyword(s):

United States ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

The United States ◽

Stroke Patients ◽

Driving Time ◽

Prehospital Triage ◽

Suspected Stroke ◽

Association Algorithm

Background and Purpose: Ischemic stroke patients with large vessel occlusion (LVO) could benefit from direct transportation to an intervention center for endovascular treatment, but non-LVO patients need rapid IV thrombolysis in the nearest center. Our aim was to evaluate prehospital triage strategies for suspected stroke patients in the United States. Methods: We used a decision tree model and geographic information system to estimate outcome of suspected stroke patients transported by ambulance within 4.5 hours after symptom onset. We compared the following strategies: (1) Always to nearest center, (2) American Heart Association algorithm (ie, directly to intervention center if a prehospital stroke scale suggests LVO and total driving time from scene to intervention center is <30 minutes, provided that the delay would not exclude from thrombolysis), (3) modified algorithms with a maximum additional driving time to the intervention center of <30 minutes, <60 minutes, or without time limit, and (4) always to intervention center. Primary outcome was the annual number of good outcomes, defined as modified Rankin Scale score of 0–2. The preferred strategy was the one that resulted in the best outcomes with an incremental number needed to transport to intervention center (NNTI) <100 to prevent one death or severe disability (modified Rankin Scale score of >2). Results: Nationwide implementation of the American Heart Association algorithm increased the number of good outcomes by 594 (+1.0%) compared with transportation to the nearest center. The associated number of non-LVO patients transported to the intervention center was 16 714 (NNTI 28). The modified algorithms yielded an increase of 1013 (+1.8%) to 1369 (+2.4%) good outcomes, with a NNTI varying between 28 and 32. The algorithm without time limit was preferred in the majority of states (n=32 [65%]), followed by the algorithm with <60 minutes delay (n=10 [20%]). Tailoring policies at county-level slightly reduced the total number of transportations to the intervention center (NNTI 31). Conclusions: Prehospital triage strategies can greatly improve outcomes of the ischemic stroke population in the United States, but increase the number of non-LVO stroke patients transported to an intervention center. The current American Heart Association algorithm is suboptimal as a nationwide policy and should be modified to allow more delay when directly transporting LVO-suspected patients to an intervention center.

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Hypoperfusion Intensity Ratio Is Correlated With Patient Eligibility for Thrombectomy

Stroke ◽

10.1161/strokeaha.118.024134 ◽

2019 ◽

Vol 50 (4) ◽

pp. 917-922 ◽

Cited By ~ 5

Author(s):

Adrien Guenego ◽

David G. Marcellus ◽

Blake W. Martin ◽

Soren Christensen ◽

Gregory W. Albers ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intensity Ratio ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Interquartile Range ◽

National Institutes Of Health ◽

Stroke Patients ◽

Magnetic Resonance Perfusion

Background and Purpose— Hypoperfusion intensity ratio (HIR) is associated with collateral status in acute ischemic stroke patients with anterior circulation large vessel occlusion. We assessed whether HIR was correlated to patient eligibility for mechanical thrombectomy (MT). Methods— We performed a retrospective cohort study of consecutive acute ischemic stroke patients with a proximal middle cerebral artery or internal carotid artery occlusion who underwent MT triage with computed tomography or magnetic resonance perfusion imaging. Clinical data, ischemic core (mL), HIR (defined as time-to-maximum [TMax] >10 seconds/TMax >6 seconds), mismatch volume between core and penumbra, and MT details were assessed. Primary outcome was favorable HIR collateral score (HIR <0.4) between patients who underwent MT (MT+) and those who did not (MT−) according to American Heart Association guidelines both in the <6 hours and 6 to 24 hours windows. Secondary outcomes were favorable HIR score in MT− subgroups (National Institutes of Health Stroke Scale <6 versus core >70 mL) and core-penumbra mismatch volumes. Patients who did not meet guidelines were not included. Results— We included 197 patients (145 MT+ and 52 MT−). MT+ patients had a significantly lower median HIR compared with MT− patients (0.4 [interquartile range, 0.2–0.5] versus 0.6 [interquartile range, 0.5–0.8]; P <0.001) and a higher mismatch volume (96 versus 27 mL, P <0.001). Among MT− patients, 43 had a core >70 mL, and 9 had a National Institutes of Health Stroke Scale <6. MT− patients with National Institutes of Health Stroke Scale <6 had a lower HIR than MT− patients with core >70 mL (0.2 [interquartile range, 0.2–0.3] versus 0.7 [interquartile range, 0.6–0.8], P <0.001) but their HIR was not significantly different that MT+ patients. Conclusions— Patients who meet American Heart Association guidelines for thrombectomy are more likely to have favorable collaterals (low HIR). HIR may be used as a marker of eligibility for MT triage.

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VA Teams Up with American Heart Association to Raise Awareness of Heart Disease in Women: Health and Fitness Event Will Run During Vermont Avenue Farmer's Market

PsycEXTRA Dataset ◽

10.1037/e657882012-001 ◽

2012 ◽

Keyword(s):

Heart Disease ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Women Health ◽

Health And Fitness

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Evidenzbasierte Indikationen zur chirurgischen Therapie extrakranieller Karotisstenosen

Nervenheilkunde ◽

10.1055/s-0038-1624401 ◽

2003 ◽

Vol 22 (05) ◽

pp. 222-232

Author(s):

H.-H. Eckstein

Keyword(s):

American Heart Association ◽

American Heart ◽

Heart Association ◽

Amaurosis Fugax

ZusammenfassungNach Durchführung prospektiv-randomisierter Studien liegen für die Karotis-Thrombendarteriektomie (KarotisTEA) höhergradiger Karotisstenosen gesicherte Indikationen auf dem Evidenzlevel Ia mit dem Empfehlungsgrad A vor. Dies betrifft sowohl >50%ige symptomatische als auch >60%ige asymptomatische Stenosen (NASCET-Kriterien). In Subgruppen-Analysen aus NASCET konnten klinische und morphologische Variablen identifiziert werden, die auf ein besonders hohes Risiko eines karotisbedingten Schlaganfalls im natürlichen Verlauf hinweisen. Patienten mit folgenden Variablen profitieren daher besonders von der Karotis-TEA: Stenosegrad >90%, schlechter Kollateralkreislauf, kontralateraler Karotisverschluss, Plaque-Ulzerationen, Tandemstenosen, intraluminale Thromben, nicht-lakunärer Hirninfarkt, Lebensalter >75 Jahre, komplexes klinisches Risikoprofil, Hemisphären-TIA (vs. Amaurosis fugax), männliches Geschlecht. Der präventive Effekt der Karotis-TEA kann jedoch nur unter Beachtung eines niedrigen perioperativen Schlaganfallbzw. Letalitätrisikos realisiert werden. Nach Empfehlungen der American Heart Association (AHA) darf das perioperative Risiko 3% bei asymptomatischen Stenosen ohne kontralaterale Stenose, 5% bei asymptomatischen Stenosen mit hochgradiger kontralateraler Stenose oder Verschluss und 6% bei symptomatischen >50%ige Stenosen (NASCET-Kriterien) nicht überschreiten. Die Ergebnisse der Qualitätssicherung Karotis-TEA der Deutschen Gesellschaft für Gefäßchirurgie (DGG) zeigen, dass diese maximal akzeptablen Obergrenzen zum Teil deutlich unterschritten werden. Vor diesem Hintergrund stellt das Stenting von Karotisstenosen einen klinischen Heilversuch dar, der nur nach interdisziplinärem Konsil und/oder i. R. randomisierter Studien zulässig ist.

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