[Identification of the factors conditioning times and indicators of quality in the intrahospital care of acute stroke].

INTRODUCTION

Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement.

AIM

To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement.

PATIENTS AND METHODS

Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed.

RESULTS

337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants.

CONCLUSIONS

Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke.