Análisis del cumplimiento de la Guía Clínica del AUGE en pacientes con accidente cerebrovascular isquémico: la utilización de tecnología sanitaria de diagnóstico para prevención secundaria en un hospital público.

Resumen

COMPLIANCE WITH CHILEAN DIAGNOSTIC GUIDELINES AMONG PATIENTS WITH ISCHEMIC STROKE ADMITTED TO A PUBLIC HOSPITAL

Background: Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform.  Aim: To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital. Patients and methods: The study included a review of the medical records of 101 patients aged 70 ±13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained observers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated.   Results: Ten patients died before discharge, 38% were discharged with and 52% were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87% of patients with a score of 3 to 5 (moderate to severe disability). In 27% of the patients, there was an overuse of diagnostic tests.  No association between the diagnostic test use adequacy and year of discharge was observed. Conclusions: There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke.