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May 16, 2019

ESOC-2019

PREDICTORS FOR SEEKING LOW COMPLEXITY EMERGENCY UNITS INSTEAD OF COMPREHENSIVE STROKE CENTERS IN BRAZIL

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acute stroke

emergency

prehospital

predictors

Abstract

Abstract

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Keywords

acute stroke

emergency

prehospital

predictors

Abstract

INTRODUCTION: In the acute stroke setting, early symptoms identification, and rapid transport to a stroke center can define treatment and prognosis. In the last decade, hundreds of low complexity Emergency Care Units (called UPA 24h) were launched in Brazil. Distributed throughout larger cities, UPA 24h are designed to provide care for patients with acute low complexity complaints. In Fortaleza, Ceará, although there is a well-organized comprehensive stroke center, UPA 24h are the second institutions most sought by patients with stroke symptoms what is associated with up to 50% decrease in ischemic stroke thrombolysis rate. OBJECTIVE: This study aimed to evaluate predictors of seeking care for acute stroke in UPA 24h besides home proximity. METHODS: Data were prospectively collected from consecutive patients admitted to 31 hospitals in Fortaleza with acute stroke from February 3 to December 31, 2014. We traced all pathways since symptom onset to hospital arrival. RESULTS: A total of 3,052 patients (mean age, 66.1 ±15.6 years; 51% men) were evaluated. Ischemic stroke was the most frequent stroke subtype (70%) followed by intraparenchymal hemorrhage (18%), subarachnoid hemorrhage (9%), and undetermined stroke (3%). Of the 2,362 patients from Fortaleza, 33% went straight to Hospital Geral de Fortaleza, our stroke center, 27% went to the UPA 24h, 18% went to private hospitals and 22% went to other institutions. Patients who typically sought UPA 24h were younger (< 50 y) (OR 1.36; 95% CI, 1.01 - 1.83; P = 0,04); had low educational levels (0R 1.53; 95% CI, 1.06 - 2.23; P=0,03); did not call EMS (OR 1.76; 95% CI, 1.32 - 2.38; P <0,001); had headache at onset (OR 1.33; 95% CI, 1.06 - 1.67; P = 0,01), had no speech deficits (OR 1.50; 95% CI, 1.16 - 1.94; P = 0,002) and were transported by their own means (OR 2.35; 95% CI, 1.59 - 3.56; P < 0,001). When adjusted for the HDI and stroke type, being a female (OR 1.34; 95% CI, 1.03 - 1.76; P = 0,03), not calling EMS (OR 2.27; 95% CI, 1.58 - 3.30; P < 0,001), having headache at onset (OR 1.37; 95% CI, 1.02 - 1.85; P = 0,04) and being transported by their own means (OR 3.06; 95% CI, 1.90 - 5.08; P < 0,001) were independent predictors of UPA 24h utilization. CONCLUSION: Our original data suggest that age, educational level, sex, headache at the onset, no speech deficits and prehospital transportation are predictors for seeking low complexity emergency units instead of comprehensive center in the acute stroke care setting. This information can guide effective public health policies to improve acute stroke care.

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© Copyright 2019 Morressier GmbH.
All rights reserved.