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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se presenta el resultado de una auditor&#237;a acerca del tratamiento de la hemorragia subaracnoidea aguda &#40;HSA&#41; en una mini-unidad de Neurocirug&#237;a de reciente creaci&#243;n y seg&#250;n un protocolo asistencial adaptado al Centro&#46; Los objetivos han sido determinar si se cumplen los m&#237;nimos necesarios para continuar con dicha actividad y detectar los aspectos que puedan incidir en una mejor&#237;a de la calidad asistencial&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudian 74 pacientes consecutivos de HSA atendidos en el per&#237;odo 1994&#8211;96&#46; En 10 casos no se encontr&#243; patolog&#237;a aneurism&#225;tica tras el estudio neurorradiol&#243;gico &#40;Grupo 1&#41;&#44; 49 pacientes fueron intervenidos por aneurisma &#40;Grupo 2A&#41; y los 15 restantes&#44; con aneurisma diagnosticado o sospechado&#44; no fueron intervenidos &#40;Grupo 2B&#41;&#46; La mortalidad total en el momento de alta es del 16&#46;2&#37; y llega al 20&#46;3&#37; a los seis meses&#46; Los buenos resultados &#40;Glasgow Outcome Scale 1 &#243; 2&#41; son del 59&#46;4&#37; al alta y del 71&#46;6&#37; a los seis meses&#46; En el Grupo 1 no hay mortalidad y los resultados buenos son del 100&#37;&#46; La mortalidad postquir&#250;rgica es del 8&#46;2&#37;&#44; lo que supone un tercio de la del Grupo 2&#46; Se estudiaron tambi&#233;n una serie de indicadores asistenciales&#44; como son el tiempo desde la HSA al ingreso y desde el ingreso a la angiograf&#237;a e intervenci&#243;n&#44; as&#237; como la estancia en Cuidados Intensivos y la estancia total&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La comparaci&#243;n de los datos obtenidos con los recogidos de la literatura demuestra que es posible proporcionar una asistencia de calidad a los pacientes con HSA en las mini-unidades de Neurocirug&#237;a&#46; En nuestro medio&#44; para llegar al tratamiento quir&#250;rgico m&#225;s precoz del aneurisma se debe reducir el tiempo de diagn&#243;stico angiogr&#225;fico y lograr una mayor disponibilidad de quir&#243;fano&#44; ya que los pacientes acceden muy pronto al hospital tras la HSA&#46;</p>"
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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results of an auditory on the treatment of acute subarachnoid hemorrhage &#40;SAH&#41; in a new Neurosurgical mini-Unit are presented&#46; A management protocol suited for our Center was developed&#46; The objectives of the study were assess if our Neurosurgical Unit reaches the standards for treatment of SAH and investigate if there are deficiencies to be ameliorated&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A consecutive series of 74 patients with SAH treated between 1994&#8211;96 are included&#46; In 10 cases neuroradiological studies did not found any vascular lesion &#40;Group 1&#41;&#44; in 49 patients an aneurysm was found and surgically treatet &#40;Group 2A&#41; and 15 patients with evidence or suspected aneurysm were no surgically treated &#40;Group 2B&#41;&#46; At the end of hospitalization the total mortality was 16&#46;2&#37; and 59&#46;4&#37; exhibited a good recovery &#40;Glasgow Outcome Scale 1 or 2&#41;&#46; At the six moth evaluation mortality was 20&#46;3&#37; and good recovery 71&#46;6&#37;&#46; There was no mortality in Group 1&#44; with a 100&#37; of favourable outcome&#46; Postoperative mortality was 8&#46;2&#37; being a third of the Group 2&#46; Sorne other sanitary indicators were studied&#58; time from SAH to admission&#44; from admission to aneurysmal diagnosis and surgical treatment&#44; intensive care unit and hospital length stay&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Comparison of our results with those obtaind from national and international literature shows that it is possible give a good quality assistance to patients with acute SAH in Neurosurgical mini-Units&#46; Considering the earIy referal of the patients to our Hospital&#44; a reduction in the time of aneurysmal diagnosis and more operative room disponihility should be necessary to achieve a more earIy surgical treatment of aneurysms&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Gonz&#225;lez-Darder&#44; J&#46;M&#46;&#59; Gil-Sal&#250;&#44; J&#46;L&#46;&#59; Barcia&#44; J&#46;A&#46;&#59; Soler&#44; F&#46;&#58; Manejo de la hemorragia subaracnoidea y de los aneurismas cerebrales en las mini-unidades de neurocirug&#237;a&#46; Resultados de una auditor&#237;a&#46; Neurocirug&#237;a 1998&#59; 9&#58; 141&#8211;151&#46;</p>"
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Vol. 9. Núm. 2.
Páginas 141-151 (enero 1998)
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Vol. 9. Núm. 2.
Páginas 141-151 (enero 1998)
Manejo de la hemorragia subaracnoidea y de los aneurismas cerebrales en las mini-unidades de Neurocirugía. Resultados de una auditoría
Management of subarachnoid hemorrage and cerebral aneurysms in a neurosurgical mini-unit. ResuIt of an audit
Visitas
2067
J.M. González-Darder, J.L. Gil-Salú, J.A. Barcia
Sección de Neurocirugía, Hospital General de Castellón
F. Soler*
* Servicio Valenciano de Salud y Servicio de Radiodiagnóstico, Clínica de Salud de Valencia
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Resumen

Se presenta el resultado de una auditoría acerca del tratamiento de la hemorragia subaracnoidea aguda (HSA) en una mini-unidad de Neurocirugía de reciente creación y según un protocolo asistencial adaptado al Centro. Los objetivos han sido determinar si se cumplen los mínimos necesarios para continuar con dicha actividad y detectar los aspectos que puedan incidir en una mejoría de la calidad asistencial.

Se estudian 74 pacientes consecutivos de HSA atendidos en el período 1994–96. En 10 casos no se encontró patología aneurismática tras el estudio neurorradiológico (Grupo 1), 49 pacientes fueron intervenidos por aneurisma (Grupo 2A) y los 15 restantes, con aneurisma diagnosticado o sospechado, no fueron intervenidos (Grupo 2B). La mortalidad total en el momento de alta es del 16.2% y llega al 20.3% a los seis meses. Los buenos resultados (Glasgow Outcome Scale 1 ó 2) son del 59.4% al alta y del 71.6% a los seis meses. En el Grupo 1 no hay mortalidad y los resultados buenos son del 100%. La mortalidad postquirúrgica es del 8.2%, lo que supone un tercio de la del Grupo 2. Se estudiaron también una serie de indicadores asistenciales, como son el tiempo desde la HSA al ingreso y desde el ingreso a la angiografía e intervención, así como la estancia en Cuidados Intensivos y la estancia total.

La comparación de los datos obtenidos con los recogidos de la literatura demuestra que es posible proporcionar una asistencia de calidad a los pacientes con HSA en las mini-unidades de Neurocirugía. En nuestro medio, para llegar al tratamiento quirúrgico más precoz del aneurisma se debe reducir el tiempo de diagnóstico angiográfico y lograr una mayor disponibilidad de quirófano, ya que los pacientes acceden muy pronto al hospital tras la HSA.

Palabras clave:
Hemorragia subaracnoidea
Aneurisma cerebral
Planificación asistencial
Abstract

The results of an auditory on the treatment of acute subarachnoid hemorrhage (SAH) in a new Neurosurgical mini-Unit are presented. A management protocol suited for our Center was developed. The objectives of the study were assess if our Neurosurgical Unit reaches the standards for treatment of SAH and investigate if there are deficiencies to be ameliorated.

A consecutive series of 74 patients with SAH treated between 1994–96 are included. In 10 cases neuroradiological studies did not found any vascular lesion (Group 1), in 49 patients an aneurysm was found and surgically treatet (Group 2A) and 15 patients with evidence or suspected aneurysm were no surgically treated (Group 2B). At the end of hospitalization the total mortality was 16.2% and 59.4% exhibited a good recovery (Glasgow Outcome Scale 1 or 2). At the six moth evaluation mortality was 20.3% and good recovery 71.6%. There was no mortality in Group 1, with a 100% of favourable outcome. Postoperative mortality was 8.2% being a third of the Group 2. Sorne other sanitary indicators were studied: time from SAH to admission, from admission to aneurysmal diagnosis and surgical treatment, intensive care unit and hospital length stay.

Comparison of our results with those obtaind from national and international literature shows that it is possible give a good quality assistance to patients with acute SAH in Neurosurgical mini-Units. Considering the earIy referal of the patients to our Hospital, a reduction in the time of aneurysmal diagnosis and more operative room disponihility should be necessary to achieve a more earIy surgical treatment of aneurysms.

Key words:
Subarachnoid hemorrhage
Cerebral aneurysm
Resource utilization

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