Implementation of a stroke registry is associated with an improvement in stroke performance measures in a tertiary hospital in Mexico.

BACKGROUND: Stroke registries provide a simple way for improving patient care, and its use has been associated with a better adherence to the published guidelines. Few Latin American countries had established stroke registries. Our study is the first in Mexico to report the effects of implementing a stroke registry. To determine if the implementation of a systematized registry is associated with an improved adherence to the performance measures. METHODS: We compared prospective data (August 2008-November 2010) against historical controls (February 2005-July 2008). Our stroke registry (i-Registro Neurovascular) consists of a standardized clinical form that includes demographic and clinical variables (risk factors, medications, neuroimaging, etiology, acute and outpatient treatments, and neurologic scores [National Institutes of Health Stroke Scale and modified Rankin Scale]). We evaluated 9 performance measures suggested by the American Heart Association and the Joint Commission. RESULTS: We analyzed the data from 574 patients, 260 from the prospective phase and 314 from historical controls. No significant statistical differences in demographic characteristics or stroke risk factors were found. The implementation of the stroke registry was associated with a statistically significant (P < .05) improvement in almost all of the acute performance measures. The composite measure also showed an improvement form 52.6%-68.8% (P < .001). CONCLUSIONS: The implementation of a systematized registry significantly improved our clinical practice. This intervention is a low cost and readily achievable and a viable option for encouraging an increased report of guidelines adherence of other hospitals in Latin America.

Knowledge of ischemic stroke risk factors and warning signs after a health education program by medical students.

BACKGROUND AND PURPOSE: A delay in recognizing early warning signs (WS) and risk factors (RF) of ischemic stroke causes a delay in treatment. We evaluated knowledge of RF and WS and the impact of an educational program by medical students. METHODS: We first surveyed individuals to determine knowledge of WS and RF. Then, after a 6-month education program, knowledge was reassessed. The questionnaire included sociodemographic and comorbidity data. A χ(2) and Mann-Whitney U test, as well as a multivariate logistic regression analysis to determine variables associated with knowledge, were used. RESULTS: We performed 329 baseline and 355 posteducation surveys. Initially, 57.1% mentioned at least 1 RF; this later increased to 65.9%. Mentions of obesity, dyslipidemias, hypertension, and diabetes mellitus increased significantly. With regard to WS, 37.6% mentioned at least 1, which increased to 48.1% who mentioned weakness in 1 limb, in half the body, severe headache, and altered vision. Educational level (OR, 2.53; 95% CI, 1.42-4.53; P=0.001), employment (OR, 1.72; 95% CI, 1.08-2.74; P=0.021), a family history of brain infarction (OR, 2.35; 95% CI, 1.35-4.11; P=0.02), obesity (OR, 1.63; 95% CI, 1.026-2.6; P=0.038), and having received information in the last 6 months (OR, 2.7; 95% CI, 1.51-4.83; P=0.001) were associated with a better understanding of RF and WS. CONCLUSIONS: The educational program was cost-effective and had a positive impact on knowledge of RF and WS of ischemic stroke. More education programs are required to improve knowledge of ischemic stroke.