Factors that can influence the length of hospital stay in patients with Ischemic Stroke
DOI:
https://doi.org/10.33448/rsd-v10i8.17107Keywords:
Neurology; Hospitalization; Ischemic Stroke; Stroke; Length of hospital stay.Abstract
Introduction: Ischemic Stroke (iCVA) consists of a cerebral arterial obstruction, which results in an acute neurological lesion with important worldwide morbidity and mortality. Representing one of the main causes of hospitalization, stroke causes long-term and high-cost hospitalizations and numerous future consequences for patients, with considerable financial expense in the health system. Such mentioned aspects can be avoided when we act on several factors that influence the length of stay (LOS) of these patients. Thus, the present study aims to identify elements that influence LOS in patients who had stroke and were assisted at a neurology and neurosurgery reference institution. Methodology: This retrospective research includes all patients with cerebral infarction between 2018-2019 and the exclusion criteria were patients with neurological pathology other than stroke, under 18 years of age or with incomplete medical records. Several variables were analyzed statistically, including demographic data, risk factors, level of consciousness, affected arterial vessel and need for neurosurgery. Results: 101 patients were eligible for the study. Average age was 73 years old, with 88,1% over 60 years old. Systemic Arterial Hypertension (SAH) was present in most patients (77,23%). The majority (85,15%) presented with a Glasgow Coma Scale (GCS) greater than 8 with statistical significance in lower mortality (p=0,015) and lower LOS (p=0,001). The middle cerebral artery (MCA) was the main arterial territory affected (58,42%) and few cases required neurosurgery (4,95%). The death rate was small (11,88%). The mean LOS was 11,31 days and most patients were hospitalized for less than five days (51,48%). Conclusion: Initial presentation with a GCS scale above 8 is consistent with lower mortality and lower LOS. Understanding factors that can induce higher LOS is of paramount importance for time management, aiming at reducing the treatment expenses and optimizing skills.
References
Asgedom, S. W., Gidey, K., Gidey, K., Niriayo, Y. L., Desta, D. M., & Atey, T. M. (2020). Medical complications and mortality of hospitalized stroke patients. Journal of Stroke and Cerebrovascular Diseases, 29(8), 104990. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104990
Dantas, L. F., Marchesi, J. F., Peres, I. T., Hamacher, S., Bozza, F. A., & Quintano Neira, R. A. (2019). Public hospitalizations for stroke in Brazil from 2009 to 2016. PLoS ONE, 14(3), 1–10. https://doi.org/10.1371/journal.pone.0213837
Feigin, V. L., Nguyen, G., Cercy, K., Johnson, C. O., Alam, T., Priyakumari G Parmar, A. A. A., Abate, K. H., Abd-Allah, F., Abejie, A. N., Abyu, G. Y., Ademi, Z., Agarwal, G., Ahmed, M. B., Akinyemi, R. O., & Rajaa A, G. A. R. (2018). Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. New England Journal of Medicine, 379(25), 2429–2437. https://doi.org/10.1056/NEJMoa1804492
Fernandes, A. M. P. da S. F., Azevedo, A. F. R., Magalhães, C. P., Antão, C. da C. M., & Anes, E. M. G. J. (2005). Avaliação do conhecimento referente à detecção precoce e prevenção do Acidente Vascular Cerebral. I Congresso de Cuidados Continuados.
Gauberti, M., De Lizarrondo, S. M., & Vivien, D. (2016). The “inflammatory penumbra” in ischemic stroke: From clinical data to experimental evidence. European Stroke Journal, 1(1), 20–27. https://doi.org/10.1177/2396987316630249
Girijala, R. L., Sohrabji, F., & Bush, R. L. (2017). Sex differences in stroke: Review of current knowledge and evidence. Vascular Medicine (United Kingdom), 22(2), 135–145. https://doi.org/10.1177/1358863X16668263
Gofir, A., Mulyono, B., & Sutarni, S. (2017). Hyperglycemia as a prognosis predictor of length of stay and functional outcomes in patients with acute ischemic stroke. International Journal of Neuroscience, 127(10), 923–929. https://doi.org/10.1080/00207454.2017.1280793
Kasner, S. E. (2006). Clinical interpretation and use of stroke scales. Lancet Neurology, 5(7), 603–612. https://doi.org/10.1016/S1474-4422(06)70495-1
Kim, S. M., Hwang, S. W., Oh, E. H., & Kang, J. K. (2013). Determinants of the Length of Stay in Stroke Patients. Osong Public Health and Research Perspectives, 4(6), 329–341. https://doi.org/10.1016/j.phrp.2013.10.008
Komolafe, M. A., Olaogu, M. O. B., Adebiyi, A. M., Obembe, A. O., Fawale, M. B., & Adebowale, A. A. (2015). Stroke risk factors among participants of a world stroke day awareness program in South-Western Nigeria. Nigerian Journal of Clinical Practice, 18(6), 807–809. https://doi.org/10.4103/1119-3077.163277
Ministério da Saúde. Envelhecimento e Saúde da Pessoa Idosa. 2. 187 p.
Mohamed, W., Bhattacharya, P., Shankar, L., Chaturvedi, S., & Madhavan, R. (2015). Which comorbidities and complications predict ischemic stroke recovery and length of stay? Neurologist, 20(2), 27–32. https://doi.org/10.1097/NRL.0000000000000040
Oliveira, J. G., Damasceno, K. G., Souza, L. P., & Lima, M. G. (2016). Perfil Clínico Epidemiológico e os Principais Rótulos Diagnósticos de Enfermagem aos Pacientes Internados com Acidente Vascular Cerebral em Um Hospital de Grande Porte na Região Sul da Amazônia Legal. Amazônia Science & Health, 4(3), 3–11. https://doi.org/10.18606/2318-1419/amazonia.sci.health.v4n3p3-11
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. UFSM.
Rosa, T. S. M., de Moraes, A. B., & Trevisan, M. E. (2015). Características clínico-demográficas de pacientes hospitalizados por acidente vascular cerebral. Revista Neurociencias, 23(3), 405–412. https://doi.org/10.4181/RNC.2015.23.03.1086.08p
Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., Elkind, M. S. V., George, M. G., Hamdan, A. D., Higashida, R. T., Hoh, B. L., Janis, L. S., Kase, C. S., Kleindorfer, D. O., Lee, J. M., Moseley, M. E., Peterson, E. D., Turan, T. N., Valderrama, A. L., & Vinters, H. V. (2013). An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke, 44(7), 2064–2089. https://doi.org/10.1161/STR.0b013e318296aeca
Somerford, P. J., Lee, A. H., & Yau, K. K. W. (2004). Ischemic stroke hospital stay and discharge destination. Annals of Epidemiology, 14(10), 773–777. https://doi.org/10.1016/j.annepidem.2004.02.003
Somotun, A. A. O., Osungbade, Omoniyi, K., Akinyemi, Oladapo, O., Obembe, Akinyode, T., Adeniji, & Ikenna, F. (2017). What factors influence the average length of stay among stroke patients in a Nigerian tertiary hospital? Pan African Medical Journal, 26, 1–7. https://doi.org/10.11604/pamj.2017.26.228.12249
Walcott, B. P., Miller, J. C., Kwon, C. S., Sheth, S. A., Hiller, M., Cronin, C. A., Schwamm, L. H., Simard, J. M., Kahle, K. T., Kimberly, W. T., & Sheth, K. N. (2014). Outcomes in severe middle cerebral artery ischemic stroke. Neurocritical Care, 21(1), 20–26. https://doi.org/10.1007/s12028-013-9838-x
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Copyright (c) 2021 Mirela Sehn; Felipe Kochhann Ledur ; Isadora Sehn; Betina Sehn; Rafael Rauber; Leandro Pelegrini de Almeida
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