[Management of stroke in a ward of internal medicine. Limits and prospects].
Precocious admission to specifically "dedicated" wards proved to improve reduction of mortality and degree of residual disability in patients with stroke, even if their inhomogeneous distribution gets most patients admitted to wards of Internal Medicine. We purposed to evaluate the importance of this problem, to check adhesion to the national guidelines and to show the main problems in management of patients with stroke in the Operative Unit of Internal Medicine, Vascular and Metabolic Diseases of the IRCCS S. Matteo Hospital of Pavia. 143 patients with stroke were admitted in 2001, 126 were ischemic, 17 hemorragic; the mean age was of 73. The most frequent risk factors were hypertension, diabetes, smoke and atrial fibrillation. 59% of patients were admitted within 6 hours from onset of symptoms. Within the ischemic subtypes, 17.5% were atherotrombothic, 16.7% cardioembolic, 23.8% lacunar and 42% with undetermined etiology. Lacunar syndromes were the most part. 80% of patients underwent computed tomography, 50% underwent epiaortic Doppler sonography, 38% echocardiography. 61% of ischemic subtypes underwent acute antiplatelet treatment. Complications were prevalent in oldest patients. Mortality of inpatients was 17%, influenced by age, hypertension, severe sensorial compromission at admission, cardioembolism and complications. This study proved leak of adhesion to national guidelines which brought to inadequate accuracy in diagnosis and difficulty in making correct and coherent therapeutic choices. At least in great hospitals, "dedicated" areas in wards of Internal Medicine with selected, trained and motivated staff should be desirable.
Negri
Monica
M
UO di Medicina Interna, Malattie Vascolari e Metaboliche, IRCCS Policlinico S. Matteo, Pavia. monica-negri@libero.it
Martignoni
Alessandra
A
Baccheschi
Jordan
J
Santilli
Giovanna
G
Marchesi
Eugenia
E
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000175:diagnosis; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D048909:Diabetes Complications; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin