Utilización de recursos sanitarios y costes asociados al manejo de los pacientes con infarto cerebral cardioembólico agudo en la Comunidad de Madrid: Estudio CODICE / Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study

Introducción: El ictus es la principal causa de ingreso en los servicios de Neurología, siendo el infarto cerebral cardioembólico (ICE) de los subtipos más frecuentes. Métodos: Estudio observacional, multicéntrico, prospectivo, realizado en 5 hospitales públicos de la Comunidad de Madrid, cuyo objetivo fue estimar la utilización de recursos sanitarios y costes en el manejo del ICE agudo. Se incluyeron pacientes con ICE agudo de evolución < 48 h. Se registraron datos sociodemográficos, clínicos y los recursos sanitarios utilizados durante el ingreso y al alta hasta 30 días desde el ingreso, incluyendo el tratamiento rehabilitador al alta. Resultados: Se seleccionaron 128 pacientes durante 8 meses, de 75,3 ± 11,25 años, siendo un 46,9% mujeres, con una mortalidad del 4,7%. El 100% cumplía los criterios diagnósticos del GEENCV-SEN por antecedentes o el estudio realizado. Como antecedentes clínicos, el 50% presentó fibrilación auricular, y el 18,8%, otras fuentes mayores embolígenas. La fibrilación auricular no valvular fue la causa más frecuente de ICE (33,6%). Consumo de recursos: estancia media, 10,3 ± 9,3 días; rehabilitación durante el ingreso, 46,9%, media 4,5 días, y al alta, 56,3%, media 26,8 días; complicaciones, 32%; intervenciones hospitalarias específicas, 19,5%; pruebas diagnósticas y analíticas sanguíneas, 100%, siendo la TAC craneal (98,4%), el dúplex TSA (87,5%) y el electrocardiograma (85,9%), las diagnósticas más frecuentes. El coste total medio por paciente en la fase aguda y rehabilitación por ICE fue de 13.139 Euros, siendo la estancia hospitalaria (45,0%) y la rehabilitación al alta (29,2%) los recursos más importantes. Conclusiones: El manejo agudo del ICE en la Comunidad de Madrid generó un importante consumo de recursos (13.139 Euros) debido a la asistencia hospitalaria y la rehabilitación

Introduction: Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. Methods: A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at < 48 h from onset were recruited. Patients’ socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. Results: During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3 ± 11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3 ± 9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was Euros 13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. Conclusions: Acute CS management in the Region of Madrid resulted consumes large amounts of resources (Euros 13,139), mainly due to hospital stays and rehabilitation

Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study.

INTRODUCTION: Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. METHODS: A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. RESULTS: During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. CONCLUSIONS: Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.

Replica. ¿Activación neuroglial en los surcos cerebrales? / Does neuroglial activation take place in the cerebral sulci? Reply

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[Acalculia: its classification, aetiology and clinical management]. / Acalculia: clasificación, etiología y tratamiento clínico.

AIM: To carry out a review of the literature on the different neurological mechanisms involved in processing calculations, the injuries to brain structure that can result in acalculia and the clinical management of these patients. Development and conclusions. Acalculia is defined as the disorder affecting the ability to calculate that is acquired as the result of a brain injury. Despite being a frequent symptom and its association to numerous systemic and neurological diseases, no clear study protocol exists due to the fact that, first, it is usually accompanied by other, more important neurological symptoms and, second, it occurs in a very heterogeneous population, where clear differences can be seen according to the sociocultural level of the patient. Acalculia has been associated both to general alterations of the central nervous system and to others affecting local structures. Perhaps the most striking example of the former is the case of dementias, where it has even been suggested that it could be an early sign of Alzheimer's disease. With respect to the latter, the most notable are those affecting the left parietal lobe. In this article the following are discussed: 1) the different classifications that have been developed for the loss of the ability to calculate; 2) the involvement of the different structures of the nervous system in numeric processing, based on the associated structural lesions and on studies that have been conducted using functional tests and brain imaging; and 3) the different neuropsychological instruments that are available to study this capacity.

Acalculia: clasificación, etiología y tratamiento clínico / Acalculia: its classification, aetiology and clinical management

Objetivo. Realizar una revisión de la bibliografía sobrelos diferentes mecanismos neurológicos implicados en el procesamientodel cálculo, las lesiones estructurales cerebrales capaces deproducir acalculia y el manejo clínico de estos pacientes. Desarrolloy conclusiones. La acalculia se define como el trastorno adquiridode la habilidad de cálculo secundario a una lesión cerebral. A pesarde ser un síntoma frecuente y asociarse a múltiples enfermedadessistémicas y neurológicas, no existe un claro protocolo de estudiodebido, en primer lugar, a que suele acompañarse de otros síntomasneurológicos de mayor importancia y, en segundo lugar, a la granheterogeneidad de la población, existiendo claras diferencias segúnel nivel sociocultural del paciente. La acalculia se ha asociado tantoa alteraciones generales del sistema nervioso central como estructuraleslocales. De entre las primeras destacan las demencias,habiéndose llegado a sugerir que podría suponer un signo precoz dela enfermedad de Alzheimer. Respecto a las segundas, destacan lasque afectan al lóbulo parietal izquierdo. En este artículo se discute:1) las diferentes clasificaciones desarrolladas para la pérdida de lahabilidad del cálculo, 2) la implicación de las diferentes estructurasdel sistema nervioso en el procesamiento numérico, con base en laslesiones estructurales asociadas y a los estudios realizados mediantepruebas funcionales y de imagen cerebral, y 3) las distintasherramientas neuropsicológicas de las que disponemos para el estudiode esta capacidad

Aim. To carry out a review of the literature on the different neurological mechanisms involved in processingcalculations, the injuries to brain structure that can result in acalculia and the clinical management of these patients.Development and conclusions. Acalculia is defined as the disorder affecting the ability to calculate that is acquired as the resultof a brain injury. Despite being a frequent symptom and its association to numerous systemic and neurological diseases, noclear study protocol exists due to the fact that, first, it is usually accompanied by other, more important neurological symptomsand, second, it occurs in a very heterogeneous population, where clear differences can be seen according to the socioculturallevel of the patient. Acalculia has been associated both to general alterations of the central nervous system and to othersaffecting local structures. Perhaps the most striking example of the former is the case of dementias, where it has even beensuggested that it could be an early sign of Alzheimer’s disease. With respect to the latter, the most notable are those affectingthe left parietal lobe. In this article the following are discussed: 1) the different classifications that have been developed for theloss of the ability to calculate; 2) the involvement of the different structures of the nervous system in numeric processing, basedon the associated structural lesions and on studies that have been conducted using functional tests and brain imaging; and3) the different neuropsychological instruments that are available to study this capacity

Amnesia global transitoria asociada a hipopotasemia / Transient global amnesia associated to hypopotassemia

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