Grupo de Estudio de Enfermedades Cerebrovasculares de la SEN

Se publica en la revista European Neurology los resultados del estudio acerca de la inciencia y manejo de los ictus que se producen en el hospital, un proyecto ictus con una larga y fructifera singladura. En el estudio han participado 13 hospitales españoles y durante el año de recogida de datos
se incluyeron 273 pacientes [156 hombres, 210 ictus isquémicos (IS), 37 ataques isquémicos transitorios (TIA) y 26] hemorragias cerebrales. La edad media fue 72 + / - 12 años. Fuentes de embolia cardiaca estaban presentes en 138 (50,5%), la retirada de los fármacos antitrombóticos en el 77 (28%) y neoplasias activas en 35 (12,8%).
Una proporción significativa de los pacientes fueron tratados con trombólisis. Sin embargo, los retrasos en contacto con el neurólogo excluyó a una proporción similar de pacientes paa este tratamiento.

Eur J Neurol. 2010 Jun 9. [Epub ahead of print] In-hospital stroke: a multi-centre prospective registry.

Vera R, Lago A, Fuentes B, Gállego J, Tejada J, Casado I, Purroy F, Delgado P, Simal P, Martí-Fábregas J, Vivancos J, Díaz-Otero F, Freijo M, Masjuan J; On behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group*.

Hospital Ramón y Cajal, Madrid, Spain.
Abstract

Background: In-hospital strokes (IHS) are relatively frequent. Avoidable delays in neurological assessment have been demonstrated. We study the clinical characteristics, neurological care and mortality of IHS. Methods: Multi-centre 1-year prospective study of IHS in 13 hospitals. Demographic and clinical characteristics, admission diagnosis, quality of care, thrombolytic therapy and mortality were recorded. Results: We included 273 IHS patients [156 men; 210 ischaemic strokes (IS), 37 transient ischaemic attacks (TIA) and 26 cerebral haemorrhages]. Mean age was 72 +/- 12 years. Cardiac sources of embolism were present in 138 (50.5%), withdrawal of antithrombotic drugs in 77 (28%) and active cancers in 35 (12.8%). Cardioembolic stroke was the most common subtype of IS (50%). Reasons for admission were programmed or urgent surgery in 70 (25%), cardiac diseases in 50 (18%), TIA or stroke in 30 (11%) and other medical illnesses in 71 (26%). Fifty-two per cent of patients were evaluated by a neurologist within 3 h of stroke onset. Thirty-three patients received treatment with tPA (15.7%). Thirty-one patients (14.7%) could not be treated because of a delay in contacting the neurologist. During hospitalization, 50 patients (18.4%) died, 41 of them because of the stroke or its complications. Conclusions: Cardioembolic IS was the most frequent subtype of stroke. Cardiac sources of embolism, active cancers and withdrawal of antithrombotic drugs constituted special risk factors for IHS. A significant proportion of patients were treated with thrombolysis. However, delays in contacting the neurologist excluded a similar proportion of patients from treatment. IHS mortality was high, mostly because of stroke.