Haemorrhagic Stroke – Clinical and Social Impact A District General Hospital’s Experience

• Autor(a) principal: Parente, Francisco
• Data de Publicação: 2002
• Outros Autores: Fernandes, Aurora, Pinheiro, Beatriz, Isidoro, António, Barbosa, Vieira, Torres, Susana, Ferreira, Ana Paula
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1858
• topic: AVC Hemorrágico; Apoio Social; GDH; Haemorrhagic stroke; Social support; DRG

Introduction and objectives – Haemorrhagic stroke is, in Portugal, unusuallyprevalent. Its diverse nature assumes equally diverse clinical presentations. The author’s objective was to characterise patients discharged, from the José Luciano CastroHospital - Anadia, with the diagnosis of haemorrhagic stroke, with respect to evolution and post-discharge planning.Patients and methodology – The clinical files of all patients admitted between 1994 and 1999 for subarachnoid and intracerebral haemorrhagic events, according to thediagnosis-related groups (DRG) database (ICD-9, codes 430 and 431) wereretrospectively reviewed. The following data was recorded: age, sex, residential area,mortality, hospital length of stay, co-morbidities, transferrals and post-discharge social planning. This data was compared and correlated to the data on ischaemic stroke for the same period.Results – There were 155 admissions for haemorrhagic stroke, corresponding to 148 patients. The population was homogeneous where residential area was concerned and accounted for 16.2% of all strokes. The average length of stay was 20.3 ± 14.1, longer in patients with infectious complications (28.3 ± 17.8 for pneumonia, 31.3 ± 12.8 for other infections) as well as for those with more than one comorbidity (32.0 ± 19.9). The prevalence of prolonged hospitalisation was 6.5%. Complications during hospitalisation occurred in 54.8% of the admissions, pneumonia being the most common complication registered (18 patients). The mortality rate was 18.1%, often early in the hospital stay (17.8% in the first day, 57.1% in the first six days) and mostly in the elderly. All these indicators were worse in comparison to those recorded for ischaemic stroke. On discharge social worker’s help was needed in 67.5% of cases.Discussion – The seriousness of haemorrhagic stroke, obvious from the indicatorsconsidered (mortality, average length of stay, transferral and comorbidities) is greater than that of other strokes, and it affects younger populations. The need for post-discharge social planning in a large number of patients is also discussed. The significant weight of these indicators and the increased hospital resources expenditure in thesecases, raises the question as to whether reimbursement should be the same as that for ischaemic stroke events, as all stroke pathology is coded similarly (DRG 14) “Specific cerebrovascular disorders, except TIA”