Quality indicators of a stroke unit in Curitiba (Brazil)

Abstract

Introduction: Stroke represents the second leading cause of death and disability in Latin America. Thus, there is a constant need to understand the profile of patients admitted for stroke, as well as to analyze the quality indicators of treatment in stroke centers. Objectives: The aim of this study was to analyze the quality indicators of a stroke center and to determine the epidemiological profile of inpatients. Methods: This is an observational cross-sectional study that included individuals admitted with stroke or transient ischaemic attack (TIA) in the stroke unit of Complexo Hospital de Clínicas da Universidade Federal do Paraná from November 2020 to October 2022. The variables and quality indicators were collected through the application of questionnaires in two moments, on admission and hospital discharge. Results: Of the 407 patients included, 49.1% were men, with a mean age of 65.4 years (standard deviation ±15.3). Ischemic stroke was the most common type of stroke (84.5%). The majority of patients (62.6%) did not receive specific intervention, while 41.9% underwent intravenous thrombolysis, with a median door-to-needle time of 30 minutes. In 69.1% of the individuals, thrombolysis started in less than 60 minutes. All patients underwent neuroimaging, 90.9% carotid imaging and 92.6% had their cardiac rhythm rated by EKG or 24h-Holter. Dysphagia screening was applied in 62.4% of the cases and smoking cessation advice was provided in 50.5%. Of the patients with ischemic stroke and TIA, only 5 (1.3%) did not receive anticoagulant or antiplatelet agent for secondary prophylaxis and in 14 (3.75%) this data was unknown. Conclusion: Intravenous thrombolysis is not performed in most hospitalized patients, however, when performed, it presents an adequate door-to-needle time. Most patients received secondary prophylaxis. Management of patients in a stroke unit allows for a thorough etiological investigation and optimization of secondary prevention and rehabilitation.