To study the epidemiology, the healthcare chain and the resource management of stroke patients in Andalousia, identifying areas of improvement.Method
A prospective observational study in 27 hospitals. Patients: they were included in the study via consecutive sampling in three crosssectional 24 h-studies (days 5,15 and 25). Period: from 5/3/98 to 25/8/98. Inclusion criteria: acute compatible clinical profile plus CT diagnosis.Results
Emergency Area population : n = 347, 81% hemorrhagic etiology, age 71% > 65 years, risk factors : hypertension in 55.8% and atrial fibrilation in 16.5%. Transport means: 48.7% own means. Hospital delay from stroke onset (T1) < 3 h, CT screening delay from emergency admission (T2): 56.8% < 3 h. ICU population: sample ICU: n = 133, (16/27 ICU and 5.9% of total patients) 83.9% hemorrhagic stroke, age < 65 years in 67.3%. Transport means to hospital : 43.8% Mobile ICU, T1 : 64.4% < 3h and T2 : 79.8% < 3 h. Severity score : APACHE III 63.2 (29.2), ICU length of stay: 12 (9.5) d, mechanical ventilation: 74.2%. Hospital mortality: 33.3% and 53 % at 1 year.Conclusions
Hospital arrival delays and CT screening must be reduced, above all in ischemic patients. Transport means are related to initial clinical severity. ACVD currently admitted to Andalusian ICU, third level hospital above all, are hemorrhagic strokes and are characterized by high severity, resource consumption, and hospital and 12 month after mortality.