Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro”
IntroductionFounded in 2019, the “ResISSSTE Cerebro” program is the first and only stroke network within the Mexican public health system. One advanced stroke center (ASC) and seven essential stroke centers (ESC) provide acute stroke (AS) care through a modified hub-and-spoke model. This study descr...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1103066/full |
| _version_ | 1828009867379474432 |
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| author | Dulce María Bonifacio-Delgadillo Enrique Castellanos-Pedroza Bernardo Alfonso Martínez-Guerra Claudia Marisol Sánchez-Martínez Juan Manuel Marquez-Romero |
| author_facet | Dulce María Bonifacio-Delgadillo Enrique Castellanos-Pedroza Bernardo Alfonso Martínez-Guerra Claudia Marisol Sánchez-Martínez Juan Manuel Marquez-Romero |
| author_sort | Dulce María Bonifacio-Delgadillo |
| collection | DOAJ |
| description | IntroductionFounded in 2019, the “ResISSSTE Cerebro” program is the first and only stroke network within the Mexican public health system. One advanced stroke center (ASC) and seven essential stroke centers (ESC) provide acute stroke (AS) care through a modified hub-and-spoke model. This study describes the workflow, metrics, and outcomes in AS obtained during the program's third year of operation.Materials and methodsParticipants were adult beneficiaries of the ISSSTE health system in Mexico City with acute focal neurological deficit within 24 h of symptom onset. Initial evaluation could occur at any facility, but the stroke team at the ASC took all decisions regarding treatment and transfers of patients. Registered variables included demographics, stroke risk factors, AS treatment workflow time points, and clinical outcome measures.ResultsWe analyzed data from 236 patients, 104 (44.3%) men with a median age of 71 years. Sixty percent of the patients were initially evaluated at the ESC, and 122 (85.9%) were transferred to the ASC. The median transfer time was 123 min. The most common risk factor was hypertension (73.6%). Stroke subtypes were ischemic (86.0%) and hemorrhagic (14.0%). Median times for onset-to-door, door-to-imaging, door-to-needle, and door-to-groin were: 135.5, 37.0, 76.0, and 151.5 min, respectively. The rate of intravenous thrombolysis was 35%. Large vessel occlusion was present in 63 patients, from whom 44% received endovascular therapy; 71.4% achieved early clinical improvement (median NIHSS reduction of 11 points). Treatment-associated morbimortality was 3.4%.ConclusionWith the implementation of a modified hub-and-spoke model, this study shows that delivery of AS care in low- and middle-income countries is feasible and achieves good clinical outcomes. |
| first_indexed | 2024-04-10T08:45:14Z |
| format | Article |
| id | doaj.art-d92f6a44ea5c419aa40c8a20bdba4a9d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-10T08:45:14Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-d92f6a44ea5c419aa40c8a20bdba4a9d2023-02-22T09:10:44ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-02-011410.3389/fneur.2023.11030661103066Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro”Dulce María Bonifacio-Delgadillo0Enrique Castellanos-Pedroza1Bernardo Alfonso Martínez-Guerra2Claudia Marisol Sánchez-Martínez3Juan Manuel Marquez-Romero4Department of Interventional Neurology, Centro Médico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de Los Trabajadores del Estado (ISSSTE), Mexico City, MexicoDepartment of Interventional Neurology, Centro Médico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de Los Trabajadores del Estado (ISSSTE), Mexico City, MexicoDepartament of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Interventional Neurology, Centro Médico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de Los Trabajadores del Estado (ISSSTE), Mexico City, MexicoDepartment of Neurology, Hospital General de Zona #2, Instituto Mexicano del Seguro Social (IMSS), Órganos de Operación Administrativa Desconcentrada (OOAD) Aguascalientes, Aguascalientes, MexicoIntroductionFounded in 2019, the “ResISSSTE Cerebro” program is the first and only stroke network within the Mexican public health system. One advanced stroke center (ASC) and seven essential stroke centers (ESC) provide acute stroke (AS) care through a modified hub-and-spoke model. This study describes the workflow, metrics, and outcomes in AS obtained during the program's third year of operation.Materials and methodsParticipants were adult beneficiaries of the ISSSTE health system in Mexico City with acute focal neurological deficit within 24 h of symptom onset. Initial evaluation could occur at any facility, but the stroke team at the ASC took all decisions regarding treatment and transfers of patients. Registered variables included demographics, stroke risk factors, AS treatment workflow time points, and clinical outcome measures.ResultsWe analyzed data from 236 patients, 104 (44.3%) men with a median age of 71 years. Sixty percent of the patients were initially evaluated at the ESC, and 122 (85.9%) were transferred to the ASC. The median transfer time was 123 min. The most common risk factor was hypertension (73.6%). Stroke subtypes were ischemic (86.0%) and hemorrhagic (14.0%). Median times for onset-to-door, door-to-imaging, door-to-needle, and door-to-groin were: 135.5, 37.0, 76.0, and 151.5 min, respectively. The rate of intravenous thrombolysis was 35%. Large vessel occlusion was present in 63 patients, from whom 44% received endovascular therapy; 71.4% achieved early clinical improvement (median NIHSS reduction of 11 points). Treatment-associated morbimortality was 3.4%.ConclusionWith the implementation of a modified hub-and-spoke model, this study shows that delivery of AS care in low- and middle-income countries is feasible and achieves good clinical outcomes.https://www.frontiersin.org/articles/10.3389/fneur.2023.1103066/fullacute ischemic strokestroke centershub-and-spokelow- and middle-income countriespublic health |
| spellingShingle | Dulce María Bonifacio-Delgadillo Enrique Castellanos-Pedroza Bernardo Alfonso Martínez-Guerra Claudia Marisol Sánchez-Martínez Juan Manuel Marquez-Romero Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro” Frontiers in Neurology acute ischemic stroke stroke centers hub-and-spoke low- and middle-income countries public health |
| title | Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro” |
| title_full | Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro” |
| title_fullStr | Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro” |
| title_full_unstemmed | Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro” |
| title_short | Delivering acute stroke care in a middle-income country. The Mexican model: “ResISSSTE Cerebro” |
| title_sort | delivering acute stroke care in a middle income country the mexican model resissste cerebro |
| topic | acute ischemic stroke stroke centers hub-and-spoke low- and middle-income countries public health |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1103066/full |
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