Evolución del protocolo de trombolisis endovenosa en ataque cerebrovascular isquémico agudo / Intravenous thrombolysis for acute ischemic stroke. A four years’ experience in a Chilean public hospital

Background: Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. Aim: To report the results a thrombolysis protocol during four years in a regional public hospital. Material and Methods: Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed. Results: The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016. Conclusions: The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.

Análisis de las consultas neurológicas en el Servicio de Urgencia de un hospital terciario / Analysis of the neurologic consultations in the Emergency Deparment at a tertiary hospital

Introducción: Las urgencias neurológicas constituyen el 10-15% de las urgencias médicas. Los principales motivos de consulta son la enfermedad cerebrovascular, crisis epilépticas y cefalea. El Hospital Dr. Hernán Henríquez A. (HHHA) comenzó con neurólogos en el Servicio de Urgencia Adultos (SUA) en horario hábil, en abril de 2011. En julio de 2013 se iniciaron turnos con neurólogo 24/7, presenciales en el SUA. Objetivo: Describir el perfil clínico de las consultas neurológicas en el SUA de nuestro centro. Método: Muestra noprobabilística, por conveniencia, de las consultas realizadas en el Turno N°1, del SUA-HHHA, entre octubre de 2013 y septiembre de 2014. El análisis estadístico se realizó con el software STATA 12.0. Resultados: Se registraron 1.080 consultas en el período. 51,2% fueron mujeres. Promedio de edad = 58 años (DE = 20,2). El 36,7% de las consultas se realizó en horario inhábil. Los diagnósticos más frecuentes fueron infarto cerebral (30,7%), epilepsia (15%) y cefalea (11,3%). El 34,6% de los pacientes fue dado de alta; 25,8% se hospitalizó en el Servicio de Medicina Interna; 21% fue derivado a otros hospitales; 12% fue derivado a otros especialistas y 5,7% ingresó a la Unidad de Paciente Crítico. 0,83% de los pacientes falleció en el SUA. Conclusiones: Los principales motivos de consulta neurológica en nuestro Servicio de Urgencia fueron enfermedades cerebrovasculares, epilepsia y cefalea. Debido a que más de un tercio de las consultas ocurre en horario inhábil, se justifica el sistema de neurología 24/7 presencial en el Servicio de Urgencia.

Introduction: Neurological emergencies constitute 10-15% of medical emergencies. The main reasons for consultation are cerebrovascular disease, seizures and headaches. Dr. Hernan Henriquez Hospital (HHHA) began with neurologists in the Adult Emergency Service in April 2011. In July 2013 24/7 neurology shifts at emergency room were added. Objective: To describe the clinical profile of neurologic consultations at our emergency center. Method: A convenience sample of consultations on shift No. 1, at the Adult Emergency Service HHHA between October 2013 and September 2014. The statistical analysis was performed using STATA 12.0 software. Results: 1,080 consultations were recorded in theperiod. 51.2% were women. Mean age = 58 years (SD = 20.2). 36.7% of consultations are conducted in a non-business hour. The most frequent diagnoses were stroke (30.7%), epilepsy (15%) and headache (11.3%). 34.6% ofpatients were discharged; 25.8% were hospitalized in the Internal Medicine dept; 21% were referred to other hospitals; 12% were referred to other specialists and 5.7% were admitted to Critical Patient Unit. 0.83% of the patients died in the SUA. Conclusions: The main reasons for neurological consultation at our Emergency Service were cerebrovascular disease, epilepsy and headaches. Because more than a third of consultations occur on non-schedule hours, neurology system 24/7 shifts are justified in the Emergency Service.