RESUMO
The three immediate causes of stroke are cervical carotid artery disease, atrial fibrillation and hypertension. Recognition and appropriate management of these causes can prevent the majority of strokes they would have caused. The purpose of this study was to develop a new protocol for screening for these causes that is more accurate, rapid and cost effective than existing protocols. In this protocol, rather than relying on auscultation with a stethoscope, the carotid artery was screened with a newly developed and more accurate quick color image scan ultrasound technique and a lead 2 EKG rhythm strip was used to find atrial fibrillation. The focus in this protocol was on the rapid detection of the three immediate causes of stroke and did not include a lengthy questionnaire or long counseling. A cholesterol determination was not included and there was little or no cost to the participants. In stroke screening trials of the new protocol at two institutions, 176 participants were screened at a rate of one every 2.7 minutes. There were 26 with > 50% carotid stenosis, 16 with previously unknown cardiac arrhythmias and 104 had hypertension. It was concluded that this protocol provides an accurate, rapid and cost-effective means of screening for the three immediate causes of stroke and can on broad application result in significant stroke reduction.
Assuntos
Transtornos Cerebrovasculares/prevenção & controle , Programas de Rastreamento/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/economia , California , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/economia , Transtornos Cerebrovasculares/economia , Transtornos Cerebrovasculares/etiologia , Colesterol/sangue , Análise Custo-Benefício , Eletrocardiografia/economia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/economia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade , Ultrassonografia Doppler em Cores/economiaRESUMO
Recent studies have shown that carotid endarterectomy for significant lesions lowers the risk of stroke and also reduces medical costs by averting the high costs of strokes. However, there has been no information on the cost effect of duplex ultrasound examination which has evolved as the prime means of discovering these carotid lesions. This study reviewed the findings and management of 100 consecutive new patients referred for duplex ultrasound management of the carotid arteries and the cost effects resulting. Seventy-three patients with < 70% stenosis were managed non-operatively; the remaining 27 with 33 lesions producing > 70% stenosis were treated by carotid endarterectomy. It was estimated that 6.5 patients would have had a stroke within 18 months if not operated on. While the medical costs of these strokes would have been $958,838, the cost of avoiding them was $300,494; the result was a significant medical costs saving of $658,344.
