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[Vertebrobasilar stroke: recording of care times and factors related to early care].

AIM
To determine the state of the vertebrobasilar stroke care chain in our hospital reference area by evaluating the factors related to stroke code activation and management times.


PATIENTS AND METHODS
Observational, analytical and retrospective study, carried out during the period 2017-2018, which includes patients admitted with a diagnosis of stroke confirmed by neuroimaging. Data were collected consecutively during assessment in the emergency department and admission to the stroke unit. Clinical factors, neurological signs and symptoms at the time of admission, detection of large-vessel occlusion and variables related to the care chain were evaluated, namely, basic medical attention, stroke code activation, onset-to-door time and door-to-imaging time.


RESULTS
Altogether 954 patients were included in the study, 233 with vertebrobasilar stroke. The onset-to-door and door-to-imaging times registered were significantly higher for posterior circulation stroke. The factors related to a lower delay in onset-to-door time were: National Institutes of Health Stroke Scale > 4, dysarthria and loss of strength. A shorter delay in door-to-imaging time was observed for the variables basic attention by medical emergency service, dysarthria, loss of strength and presence of more than one symptom/sign. Predictive variables for stroke code activation were a history of smoking, clinical signs of dysarthria or loss of strength, and the presence of more than one clinical manifestation.


CONCLUSIONS
In the pre-hospital phase is is difficult to identify vertebrobasilar stroke, which causes delays in care times. Training in knowledge of the clinical features of vertebrobasilar stroke could allow these times to be optimised.