Arrival time at a referral hospital and functional disability of people with stroke
a cohort study
Keywords:
stroke, Functional status, Epidemiology, Risk factors, Ischemic strokeAbstract
BACKGROUND: Stroke is a major cause of death and functional disability worldwide. Knowledge of the associated factors is essential for defining education, management, and healthcare strategies. OBJECTIVE: To analyze the association between arrival time at a neurology referral hospital (ATRH) and functional disability in patients with ischemic stroke 90 days after the event. DESIGN AND SETTING: Prospective cohort study conducted at a public institution of higher education in Brazil. METHODS: This study included 241 people aged ≥ 18 years who presented ischemic stroke. The exclusion criteria were death, inability to communicate without companions who could answer the research questions, and > 10 days since ictus. Disability was assessed using the Rankin score (mR). Variables for which associations showed a P value ≤ 0.20 in bivariate analysis were tested as modifiers between ATRH and disability. Significant interaction terms were used for multivariate analysis. Multivariate logistic regression analysis was performed with all variables, arriving at the complete model and adjusted beta measures. The confounding variables were included in the robust logistic regression model, and Akaike’s Information Criterion was adopted to choose the final model. The Poisson model assumes a statistical significance of 5% and risk correction. RESULTS: Most participants (56.0%) arrived at the hospital within 4.5 hours of symptom onset, and 51.7% presented with mRs of 3 to 5 after 90 days of ictus. In the multivariate model, ATRH ≥ 4.5 hours and females were associated with more significant disability. CONCLUSIONS: Arrival at the referral hospital 4.5 hours after the onset of symptoms or wake-up stroke was an independent predictor of a high degree of functional disability.
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References
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22. Erratum in: Lancet. 2020;396(10262):1562. PMID: 33069326; https://doi.org/10.1016/S0140-6736(20)30925-9.
Purroy F, Vena A, Forné C, et al. Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients. Cerebrovasc Dis. 2019;47(3-4):151-64. PMID: 31055571; https://doi.org/10.1159/000500205.
Ouriques Martins SC, Sacks C, Hacke W, et al. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol. 2019;18(7):674-83. Erratum in: Lancet Neurol. 2019;18(7):e6. Erratum in: Lancet Neurol. 2019;18(11):e9. PMID: 31029579; https://doi.org/10.1016/S1474-4422(19)30068-7.
Fonseca ARR, Murari RSW, Fonseca AJ, Buenafuentes SMF. Impacto socioeconômico do acidente vascular cerebral no estado de roraima: em estudo de coorte de base hospitalar. Revista Brasileira de Neurologia e Psiquiatria. 2018;22(2):124-41. Available from: https://rbnp.emnuvens.com.br/rbnp/article/view/215/153. Accessed in 2022 (Dec 7).
Matos I, Fernandes A, Maso I, et al. Investigating predictors of community integration in individuals after stroke in a residential setting: A longitudinal study. PLoS One. 2020;15(5):e0233015. PMID: 32421731; https://doi.org/10.1371/journal.pone.0233015.
Teixeira CP, Silva LD. As Incapacidades Físicas De Pacientes Com Acidente Vascular Cerebral : Ações De Enfermagem. Enfermería Global. 2009;15(Febrero):1-12. Available from: https://scielo.isciii.es/pdf/eg/n15/pt_revision1.pdf. Accessed in 2022 (Dec 7).
Le SM, Copeland LA, Zeber JE, et al. Factors affecting time between symptom onset and emergency department arrival in stroke patients. eNeurologicalSci. 2020;21:100285. PMID: 33204859; https://doi.org/10.1016/j.ensci.2020.100285.
Dantas LF, Marchesi JF, Peres IT, et al. Public hospitalizations for stroke in Brazil from 2009 to 2016. PLoS One. 2019;14(3):e0213837. PMID: 30889198; https://doi.org/10.1371/journal.pone.0213837.
Oliveira GMM, Brant LCC, Polanczyk CA, et al. Cardiovascular Statistics- Brazil 2020. Arq Bras Cardiol. 2020;115(3):308-439. PMID: 33027364; https://doi.org/10.36660/abc.20200812.
Al-Senani F, Al-Johani M, Salawati M, et al. A national economic and clinical model for ischemic stroke care development in Saudi Arabia: A call for change. Int J Stroke. 2019;14(8):835-42. PMID: 31122171; https://doi.org/10.1177/1747493019851284.11.
Baggio JA, Santos-Pontelli TE, Cougo-Pinto PT, et al. Validation of a structured interview for telephone assessment of the modified Rankin Scale in Brazilian stroke patients. Cerebrovasc Dis. 2014;38(4):297-301. PMID: 25412853; https://doi.org/10.1159/000367646.
Barella RP, Duran VAA, Pires AJ, Duarte RO. Perfil do atendimento de pacientes com acidente vascular cerebral em um hospital filantrópico do sul de Santa Catarina e estudo de viabilidade para implantação da Unidade de AVC. ACM Arq Catarin Med. 2019;48(1):131-43.
Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med. 2019;380(19):1795-803. Erratum in: N Engl J Med. 2021;384(13):1278. PMID: 31067369; https://doi.org/10.1056/NEJMoa1813046.
Chen X, Delcourt C, Sun L, et al. Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm. Cerebrovasc Dis. 2020;49(4):427-36. PMID: 32702699; https://doi.org/10.1159/000509226.
Fraticelli L, Freyssenge J, Claustre C, et al. Sex-Related Differences in Management and Outcome of Acute Ischemic Stroke in Eligible Patients to Thrombolysis. Cerebrovasc Dis. 2019;47(3-4):196-204. PMID: 31121582; https://doi.org/10.1159/000500901.
Dutra MOM, Coura AS, França ISX, Enders BC, Rocha MA. Sociodemographic factors and functional capacity of elderly affected by stroke. Rev Bras Epidemiol. 2017;20(1):124-35. PMID: 28513800; https://doi.org/10.1590/1980-5497201700010011.
Berglund A, Schenck-Gustafsson K, von Euler M. Sex differences in the presentation of stroke. Maturitas. 2017;99:47-50. PMID: 28364868; https://doi.org/10.1016/j.maturitas.2017.02.007.
Song T, Pan Y, Chen R, et al. Is there a correlation between socioeconomic disparity and functional outcome after acute ischemic stroke? PLoS One. 2017;12(7):e0181196. PMID: 28746347; https://doi.org/10.1371/journal.pone.0181196.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Especializada. Manual de rotinas para atenção ao AVC/Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Especializada. Brasília: Editora do Ministério da Saúde; 2013. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_rotinas_para_atencao_avc.pdf. Accessed in 2022 (Dec 7).
O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-75. PMID: 27431356; https://doi.org/10.1016/S0140-6736(16)30506-2.
Heitsch L, Ibanez L, Carrera C, et al. Early Neurological Change After Ischemic Stroke Is Associated With 90-Day Outcome. Stroke. 2021;52(1):132-41. PMID: 33317415; https://doi.org/10.1161/STROKEAHA.119.028687.
Fialho Silva IT, Assis Lopes P, Timotio Almeida T, et al. Impact of Delirium and Its Motor Subtypes on Stroke Outcomes. Stroke. 2021;52(4):1322-9. PMID: 33719516; https://doi.org/10.1161/STROKEAHA.120.026425.
Baptista SCPD, Juliani CMCM, Olbrich SRLR, et al. Avaliação dos indicadores de óbito e incapacidade dos pacientes atendidos em uma unidade de acidente vascular cerebral. Texto Context - Enferm. 2018;27(2):e1930016. https://doi.org/10.1590/0104-070720180001930016.
Yuan HW, Yang YN, Chen HF, et al. Rise in Low-Density Lipoprotein Cholesterol during Hospitalization is Related with Poor Outcome at Discharge in Patients with Acute Ischemic Stroke. Cerebrovasc Dis. 2020;49(1):88-96. PMID: 31995799; https://doi.org/10.1159/000505615.
Kuster GW, Bueno Alves M, Cendoroglo Neto M, Silva GS. Determinants of emergency medical services use in a Brazilian population with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2013;22(3):244-9. PMID: 21963219; https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.08.007.
Adeoye O, Hornung R, Khatri P, Kleindorfer D. Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke. 2011;42(7):1952-5. PMID: 21636813; https://doi.org/10.1161/STROKEAHA.110.612358.
Todo K, Sakai N, Imamura H, et al. Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days. Cerebrovasc Dis. 2019;47(3-4):127-34. PMID: 30965319; https://doi.org/10.1159/000499190.
Vieira LGDR, Safanelli J, Araujo T, et al. The cost of stroke in private hospitals in Brazil: A one-year prospective study. Arq Neuropsiquiatr. 2019;77(6):393-403. PMID: 31314841; https://doi.org/10.1590/0004-282X20190056.
Ng SH, Wong AWK, Chen CH, et al. Stroke Factors Associated with Thrombolysis Use in Hospitals in Singapore and US: A Cross-Registry Comparative Study. Cerebrovasc Dis. 2019;47(5-6):291-8. PMID: 31434100; https://doi.org/10.1159/000502278.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à reabilitação da pessoa com acidente vascular cerebral/Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. Brasília: Ministério da Saúde; 2013. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_atencao_reabilitacao_acidente_vascular_cerebral.pdf. Accessed in 2022 (Dec 7).
Silva GS, Lopes RD. Management of Antithrombotic Therapy in Stroke Patients? Rev Soc Cardiol Estado de São Paulo. 2018;28(3):267-75. Available from: https://socesp.org.br/revista/assets/upload/revista/14019878481539115089pdfptMANEJO%20DA%20TERAPIA%20ANTITROMB%C3%93TICA%20EM%20PACIENTES%20COM%20ACIDENTE%20VASCULAR%20CEREBRAL%20-%20ONDE%2-0ESTAMOS%20EM%202018_REVISTA%20SOCESP%20V28%20N3.pdf. Accessed in 2022 (Dec 7).
Paciaroni M, Bandini F, Agnelli G, et al. Hemorrhagic Transformation in Patients with AcuteIischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes. J Am Heart Assoc. 2018;7(22):e010133. PMID: 30571487; https://doi.org/10.1161/JAHA.118.010133.
Muniz LS, Santos CF, Moraes MDA, et al. Training experience with community health agents: Focus on prevention and identification of stroke. Journal of Nursing Education and Practic. 2021;11(7):63. https://doi.org/10.5430/jnep.v11n7p63.
