Abstract
Given the current orientation towards the early treatment of stroke, this multicenter study was carried out in Northeast Italy in order to examine the times between stroke onset and hospital admission, and the possible factors leading to a lengthening of such times. An analysis was made of 348 patients, 79.8% of whom had experienced an ischemic cerebral infarct. Arrival times were not significantly modified by the distance from hospital, age, family cohabitation, socio-cultural level, population density or the geographical location of the Center. Sixty percent of the ischemic stroke cases arrived at the Emergency Department within three hours, and 80% within six hours; the hemorrhagic cases arrived earlier, 100% of them by the tenth hour. The duration of stay in the Emergency Department did not vary in relation to the severity or type of stroke. Greater severity, a reduced level of awareness and daytime onset led to a moderately significant reduction in presentation times. In conclusion, the majority of patients arrived sufficiently quickly to be treated within the “therapeutic window”; nevertheless, an information campaign may be useful in accelerating the hospital presentation of the albeit limited number of cases who arrive late.
Sommario
In considerazione degli attuali orientamenti verso una terapia precoce dell'ictus, è stato compiuto uno studio multicentrico nelle regioni del nord-est italiano per esaminare i tempi intercorrenti tra l'insorgenza dell'ictus ed il ricovero in ospedale ed i possibili fattori determinanti un allungamento di tali tempi. Sono stati analizzati 348 casi, 79,8% dei quali con infarto cerebrale ischemico. La distanza dall'ospedale, l'età, la convivenza con famigliari, il livello socioculturale e le caratteristiche di densità di popolazione o di ubicazione geografica del Centro non hanno modificato in misura significativa i tempi di arrivo. Il 60% degli ictus ischemici si è presentato in Pronto Soccorso entro 3 ore e l'80% entro 6 ore; gli emorragici sono giunti più precocemente raggiungendo il 100% alla decima ora. I tempi di permanenza in Pronto Soccorso non sono variati in rapporto alla diversa gravità o al diverso tipo di ictus. La maggior gravità, il ridotto livello di vigilanza e l'esordio diurno hanno determinato tempi di presentazione ridotti in misura moderatamente significativa. In conclusione, la maggioranza dei pazienti giunge all'osservazione in tempi sufficientemente brevi per poter usufruire di un trattamento entro la “finestra terapeutica”. Tuttavia, potrebbe essere utile una campagna informativa allo scopo di accelerare l'accesso della pur ridotta percentuale di casi che si presentano tardivamente.
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Salsa F., Bragagnolo L. —Divisione Neurologica, Bassano
Marini B. —Divisione Neurologica, Belluno
Rizzo E. —Divisione Geriatrica, Camposampiero
Manzoni S. —Divisione Neurologica, Camposampiero
Lusiani L., Maccarone G. —Cl. Medica e Div. Neurologica, Castelfranco
Pistollato L. —Divisione Neurologica, Este
Pistollato G. —Divisione Neurologica, Mestre
Malferrari G. —Div. Medicina Generale I, Modena
Turrin M. —Divisione Geriatrica, Monselice
Meneghetti G. —Clinica Neurologica, Padova
Tiraferri E. —Pronto Soccorso e Astanteria, Rimini
Chiodo Grandi F. —Divisione Neurologica, Trieste
Tonizzo M. —Clinica Medica, Trieste
Carraro N. —Clinica Neurologica, Trieste
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Pistollato, G., Ermani, M. & the Italian SINV (Società Interdisciplinare Neurovascolare) Study Group. Time of hospital presentation after stroke. A multicenter study in north-east Italy. Ital J Neuro Sci 17, 401–407 (1996). https://doi.org/10.1007/BF01997714
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DOI: https://doi.org/10.1007/BF01997714