Publication: Análisis del manejo extrahospitalario del ictus en fase aguda en la Comunidad de Madrid durante el año 2013 por el SUMMA 112
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2017-09-19
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Universidad Complutense de Madrid
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Abstract
El manejo extrahospitalario del Ictus en fase aguda por los servicios de Urgencias y Emergencias no es bien conocido debido a la escasez de estudios sobre aplicación de protocolos y guías basadas en la evidencia, ya que la mayoría de lo publicado se refiere al ámbito hospitalario. En España, el Ictus es la segunda causa de mortalidad en general y la primera específicamente en mujeres, así como la primera causa de discapacidad y la segunda de demencia en mayores de 65 años. La creación de las unidades de Ictus y del Código Ictus, son la mejor contribución para su manejo adecuado en fase aguda, con una disminución de la morbimortalidad. En la llamada "Cadena Asistencial" los S.E.M. son una pieza fundamental en el acceso a un hospital con unidad de Ictus. En la Comunidad de Madrid hay 7 hospitales de la red pública con unidad de Ictus. El objetivo del presente trabajo es describir la actuación del SUMMA 112, desde que el CCU recibe una llamada y activa el recurso correspondiente, hasta la llegada al hospital una vez manejado el paciente. El estudio constata un infradiagnóstico de Ictus, debido a la escasa valoración neurológica, generando diagnósticos inadecuados, tales como DNNE y SCA que suman un 80,2%. También origina el traslado de 52,7% de pacientes con Ictus, 59,6% de pacientes con AIT en recursos sin personal sanitario y ocasiona en un porcentaje elevado el traslado de estos pacientes a hospitales sin unidad de ictus. El manejo inadecuado produce un abordaje no resolutivo de las complicaciones en la fase prehospitalaria. Dichas complicaciones son: Alteraciones de la presión sanguínea, glucemia, temperatura, ventilación y convulsiones.
The outpatient management of acute stroke in the Emergency services is not well known due to the scarcity of studies on implementation of protocols and guidelines based on evidence, as most of the literature refers to hospitals. In Spain, the Stroke is the second leading cause of mortality in general and specifically the first in women and the leading cause of disability and the second of dementia in people over 65 years. The creation of stroke units and stroke code, are the best contribution to their proper management in the acute phase, with decreased morbidity and mortality. The "care chain" of the S.E.M, are a cornerstone of access to hospital with stroke unit. In the Community of Madrid are 7 network hospitals with stroke unit. The aim of this paper is to describe the performance of the SUMMA 112, since the CCU receives a call and activates the corresponding resource until arrival at the hospital once the patient handled. The study noted a stroke underdiagnosed due to poor neurological assessment, generating inadequate, such as SCA and DNNE totaling 80.2% diagnostics. Also causes the transfer of 52.7% of patients with stroke, 59.6% of TIA patients without health personnel resource and causes a high percentage of the transfer of these patients to hospitals without stroke unit. Inadequate management approach produces an operative complications in the prehospital phase. Such complications include: changes in blood pressure, blood glucose, temperature, ventilation and seizures.
The outpatient management of acute stroke in the Emergency services is not well known due to the scarcity of studies on implementation of protocols and guidelines based on evidence, as most of the literature refers to hospitals. In Spain, the Stroke is the second leading cause of mortality in general and specifically the first in women and the leading cause of disability and the second of dementia in people over 65 years. The creation of stroke units and stroke code, are the best contribution to their proper management in the acute phase, with decreased morbidity and mortality. The "care chain" of the S.E.M, are a cornerstone of access to hospital with stroke unit. In the Community of Madrid are 7 network hospitals with stroke unit. The aim of this paper is to describe the performance of the SUMMA 112, since the CCU receives a call and activates the corresponding resource until arrival at the hospital once the patient handled. The study noted a stroke underdiagnosed due to poor neurological assessment, generating inadequate, such as SCA and DNNE totaling 80.2% diagnostics. Also causes the transfer of 52.7% of patients with stroke, 59.6% of TIA patients without health personnel resource and causes a high percentage of the transfer of these patients to hospitals without stroke unit. Inadequate management approach produces an operative complications in the prehospital phase. Such complications include: changes in blood pressure, blood glucose, temperature, ventilation and seizures.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Anatomía y Embriología Humanas, leída el 27/01/2016