Introduction. L’accident vasculaire cérébral (AVC) est une pathologie fréquente et grave, initialement souvent prise en charge dans les services d’urgences. Cette étude prospective a été menée aux urgences pendant 2 mois pour évaluer les modalités de prise en charge des patients adressés pour suspicion d’AVC ou AIT. Méthodes. Tous les patients ont été suivis jusqu’à leur sortie ou un mois après l’admission. Une analyse descriptive des données, et une comparaison des paramètres de prise en charge selon le service d’admission (Service d’Accueil des Urgences ou Unité de Proximité d’Accueil, Traitement et d’Orientation des Urgences) ont été effectuées. Résultats. Cinq cent quatre-vingt-dix-huit patients ont été inclus. Quarante pour cent d’entre eux étaient arrivés dans les 3 premières heures, un scanner X cérébral était effectué dans 91 p. 100 des cas et 36 p. 100 d’entre eux étaient hospitalisés en neurologie. À J7, 40 p. 100 des patients étaient dépendants (score de Rankin > 3). La durée moyenne de séjour était de 11 jours, le taux de mortalité à un mois de 20 p. 100. Les facteurs associés au décès étaient l’âge et un score de Glasgow initial inférieur à 10. Conclusion. Ce travail reflète les modalités de prise en charge des patients admis pour une pathologie neuro-vasculaire en région Centre, avant la création de filières spécialisées.

Introduction. Stroke is a leading cause of death and disability. Patients with suspected stroke are usually managed in emergency departments (ED). Stroke units must be created in our country, but only few French epidemiological data are available to define needs in stroke care. Objective. A prospective study was planned to evaluate epidemiology and stroke care for patients with suspected stroke admitted in the 22 ED of our region in the center of France during a two-month period. Methods. Patients with suspected stroke seen at the 22 ED were prospectively followed until discharge or one month after admission. Data on demographic characteristics, mode of transport, delay of arrival and imaging, clinical findings at arrival, department of admission, diagnosis, Rankin scale at day 7, in-hospital mortality, and outcome at a month were collected. A global statistical analysis and a comparison between rural and urban ED were performed. Results. Five hundred and ninety-eight patients were included. Mean age was 75 years. Median admission delay was 4 hours and 52 minutes. Predominant mode of transport was a private ambulance. A CT scan was obtained in 91 p.cent of cases with a median delay of 2 hours and 30 minutes. Only a third of the patients were admitted in departments of Neurology. Final diagnosis was: ischemic stroke (61 p.cent), transient ischemic attack (16 p.cent), hemorrhagic stroke (10 p.cent), other vascular disease (3 p.cent), non vascular disease (10 p.cent). In-hospital mortality was 20 p.cent, factors significantly associated with death rate were elevated age and a Glasgow coma scale ≪ 10 at admission. Mean length of stay was 12 days for stroke patients. At one month, 63 percent of patients were discharged to their home, 28 percent were transferred to an institution or in a rehabilitation unit, and 15 percent were still hospitalized. Significant differences in stroke care were found between rural and urban ED. Conclusion. This prospective study provides epidemiological data for our region. Creation of stroke units and definition of acute stroke networks are necessary to improve stroke care.