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Letter to the Editor
Reply to emergency stroke care in Spain's “Stroke belt”
Respuesta a «La atención urgente al ictus en el “Cinturón del ictus” español»
E.M. Martínez Fernandez
Unidad de Gestión Clínica de Neurología, Intercentros Hospital Juan Ramón Jiménez y Hospital Infanta Elena, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I have carefully read the comments on the article &#8220;Impact of introducing neurology into a local hospital in Andalusia&#8221;&#46; When evaluating this article&#44; we must be mindful that it is neither a clinical trial nor a prospective study&#46; It simply describes retrospective data gathering for the purpose of studying a specific situation that is very common in Andalusia&#58; stroke care in hospitals which do not have and have never had neurologists on staff&#46; We felt this provided an excellent opportunity to compare data from the first year a neurologist was working in one such hospital&#44; keeping in mind that the situation probably resembled that before the neurologist was present&#46; The situation may have evolved in later years as specialists in internal medicine expanded their knowledge due to contact with the neurologist&#46; Our intention was to gain an understanding of the true situation of stroke patients in hospitals without neurologists&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">While it is true that a retrospective observational study has less validity than a prospective study or clinical trial&#44; there was probably no other way to perform this particular study&#46; The article clearly explains that the groups differed in their baseline characteristics since assignment was not random&#46; Younger patients with more severe stroke &#40;intracranial haemorrhage&#41; were habitually assigned to the neurology department&#44; whereas older patients and those with TIA were referred to internal medicine&#46; When the neurologist was not present &#40;due to vacations&#44; conferences&#44; etc&#46;&#41;&#44; all stroke patients were referred to internal medicine&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study examined whether age or stroke subtype &#40;ischaemic or haemorrhagic&#41; affected mortality&#44; dependency&#44; or institutionalisation&#46; We concluded that the stroke subtype displayed no effect&#44; and that while age did not affect mortality&#44; it did have an impact on dependency and institutionalisation&#44; which both increased with the patient&#39;s age&#46; The beneficial results of providing neurological care were adjusted for patient age and stroke subtype&#44; and they are therefore independent from these factors&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">&#8216;Spain&#39;s stroke belt&#8217; does indeed refer to a geographical area &#40;Andalusia and Murcia&#41; with a higher stroke-related mortality rate&#46; In contrast&#44; the REGARDS study analysed risk factors associated with the increase in stroke incidence in specific regions of the United States&#46; Incidence and mortality are distinct concepts that should not be used interchangeably&#46; It is clear that a higher stroke incidence rate must be linked to risk factors and not to the presence or absence of neurological care&#46; Likewise&#44; it is obvious that increased mortality would be associated with poorer patient care&#46;</p></span>"
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Article information
ISSN: 21735808
Original language: English
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