[Vertebrobasilar stroke: recording of care times and factors related to early care]. / Ictus vertebrobasilar: registro de tiempos de asistencia y factores relacionados con la atención precoz.

AIM: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

TITLE: Ictus vertebrobasilar: registro de tiempos de asistencia y factores relacionados con la atención precoz.Objetivo. Conocer el estado de la cadena asistencial del ictus vertebrobasilar en el área de referencia de nuestro centro hospitalario, evaluando los factores relacionados con la activación del código ictus y tiempos de actuación. Pacientes y métodos. Estudio observacional, analítico y retrospectivo, realizado durante el período 2017-2018, que incluye a pacientes ingresados con diagnóstico de ictus confirmado por neuroimagen. Se recogieron los datos de manera consecutiva durante su valoración en urgencias e ingreso en la unidad de ictus. Se evaluaron factores clínicos, síntomas y signos neurológicos en el momento del ingreso, detección de oclusión de gran vaso y variables relacionadas con la cadena asistencial: primera asistencia, activación de código ictus, tiempo inicio-puerta y tiempo puerta-imagen. Resultados. Se incluyó a 954 pacientes, 233 con ictus vertebrobasilar. Los tiempos inicio-puerta y puerta-imagen registrados fueron significativamente mayores para el ictus de circulación posterior. Los factores relacionados con menor retraso en el tiempo inicio-puerta fueron: National Institute of Health Stroke Scale > 4, disartria y pérdida de fuerza. Se observó un menor retraso en el tiempo puerta-imagen para las variables: primera asistencia por servicio de emergencias médicas, disartria, pérdida de fuerza y presencia de más de un síntoma/signo. Fueron variables predictoras de activación del código ictus el antecedente de fumador, la clínica de disartria o pérdida de fuerza, y la presencia de más de una manifestación clínica. Conclusiones. Existen dificultades en la fase prehospitalaria para identificar el ictus vertebrobasilar, lo cual origina retrasos en los tiempos de asistencia. La formación en conocimientos sobre la clínica de ictus vertebrobasilar podría permitir la optimización de esos tiempos.

Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.

[Nursing report for patient discharge. A practical service experience]. / Informe de enfermería al alta. Una experiencia en la práctica asistencial.

The report for Medical Release Certificates which nurses fill out for patients after a period of hospitalization is one of the indispensable requirements that guarantee the continuity of treatment. Nursing professionals have the obligation to develop the mechanisms which allow for their services to be provided to the general public in an integrated, continuous manner. On the other hand, health service clients demand rapid, individualized, high quality treatment. Health service administrators, echoing these demands, pursue interdepartmental coordination and efficiency from health service system. This purpose of this article is to supply regulated information to the patient and his/her family as well as to health professionals which will serve as a guide while filling out the hospital medical release certificate. To this end, by means of a consensus among groups of experts, a document for medical release certificate reports, emission circuits, transfer of forms and their filing was elaborated. Furthermore, an attempt was made to introduce these reports as a habitual part in the procedures nurses follow while treating patients. The document designed and the circuits correspond to, in reality, the needs for regulated information. Other organizations have not stated any inconveniences to accepting this document and nurses are filling out these reports as the final part of the treatment process they lend to their patients. This document and its procedures guarantee its availability to all interested parties while increasing and accelerating interprofessional communication; in addition, this information is differentiated according to the needs of the receiver.