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Implementación de una Unidad Destinada a Ictus y Patología Cardiovascular (Unidad Vascular) en un Servicio de Urgencias Saturado de un Hospital Público Terciario en Brasil: Impacto en los Porcentajes de Mortalidad
Author(s) -
Nasi Luiz A.,
FerreiraDaSilva Andre L.,
Martins Sheila C.O.,
Furtado Mariana V.,
Almeida Andrea G.,
Brondani Rosane,
Wirth Letícia,
Kluck Marisa,
Polanczyk Carisi A.
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12291
Subject(s) - medicine , case fatality rate , acute coronary syndrome , emergency medicine , emergency department , stroke (engine) , mortality rate , overcrowding , myocardial infarction , epidemiology , mechanical engineering , psychiatry , engineering , economics , economic growth
Background Emergency department ( ED ) care for acute vascular diseases faces the challenge of overcrowding. A vascular unit is a specialized, protocol‐oriented unit in the ED with a team trained to manage acute vascular disorders, including stroke, coronary syndromes, pulmonary embolism ( PE ), and aortic diseases. Objectives The objective was to compare case fatality rates for selected cardiovascular conditions before and after the implementation of a vascular unit. Methods Patients with the selected diagnoses admitted to the ED in two different time periods, 2002 through 2005 (before unit opening) and 2007 to 2010 (after vascular unit opening), were identified by ICD ‐10 codes, and their electronic records were reviewed. Case fatality rates were calculated and compared for both time periods. Results The period prior to unit implementation (2002 through 2005) included 4,164 patients, and the vascular unit period (2007 to 2010) included 6,280 patients. Overall, the case fatality rate for acute vascular conditions decreased from 9% to 7.3% with vascular unit implementation (p = 0.002). The in‐hospital mortality rates for acute coronary syndrome ( ACS ) dropped from 6% to 3.8% (p = 0.003), and for acute PE dropped from 32.1% to 10.8% (p < 0.001). The stroke case‐fatality rate did not decrease despite improvements in the quality of stroke health care indicators. Conclusions The vascular unit strategy has the potential to reduce overall mortality for most acute vascular conditions.