Beltrán-Rodríguez I, Tejada-García J, Durán-Borrella O, Rodrigo-Stevens G, García-Vieitez J J
Complejo Asistencial Universitario de León, 24001 León, España.
Universidad de León, 24071 León, España.
Rev Neurol. 2020 Nov 1;71(9):326-334. doi: 10.33588/rn.7109.2020089.
To determine the state of the vertebrobasilar stroke care chain in our hospital reference area by evaluating the factors related to stroke code activation and management times.
Observational, analytical and retrospective study, carried out during the period 2017-2018, which includes patients admitted with a diagnosis of stroke confirmed by neuroimaging. Data were collected consecutively during assessment in the emergency department and admission to the stroke unit. Clinical factors, neurological signs and symptoms at the time of admission, detection of large-vessel occlusion and variables related to the care chain were evaluated, namely, basic medical attention, stroke code activation, onset-to-door time and door-to-imaging time.
Altogether 954 patients were included in the study, 233 with vertebrobasilar stroke. The onset-to-door and door-to-imaging times registered were significantly higher for posterior circulation stroke. The factors related to a lower delay in onset-to-door time were: National Institutes of Health Stroke Scale > 4, dysarthria and loss of strength. A shorter delay in door-to-imaging time was observed for the variables basic attention by medical emergency service, dysarthria, loss of strength and presence of more than one symptom/sign. Predictive variables for stroke code activation were a history of smoking, clinical signs of dysarthria or loss of strength, and the presence of more than one clinical manifestation.
In the pre-hospital phase is is difficult to identify vertebrobasilar stroke, which causes delays in care times. Training in knowledge of the clinical features of vertebrobasilar stroke could allow these times to be optimised.
通过评估与卒中代码激活及处理时间相关的因素，确定我院参考区域内椎基底动脉卒中护理链的状况。
2017年至2018年期间进行的观察性、分析性和回顾性研究，纳入经神经影像学确诊为卒中的患者。在急诊科评估及入住卒中单元期间连续收集数据。评估临床因素、入院时的神经体征和症状、大血管闭塞的检测以及与护理链相关的变量，即基本医疗护理、卒中代码激活、发病至入院时间和入院至影像学检查时间。
共954例患者纳入研究，其中233例为椎基底动脉卒中。后循环卒中的发病至入院时间和入院至影像学检查时间显著更长。与发病至入院时间延迟较短相关的因素有：美国国立卫生研究院卒中量表评分>4、构音障碍和肌力丧失。对于医疗急救服务的基本护理、构音障碍、肌力丧失以及存在一种以上症状/体征这些变量，观察到入院至影像学检查时间延迟较短。卒中代码激活的预测变量为吸烟史、构音障碍或肌力丧失的临床体征以及存在一种以上临床表现。
在院前阶段难以识别椎基底动脉卒中，这导致护理时间延迟。对椎基底动脉卒中临床特征知识的培训可使这些时间得到优化。
