Severidade e prognóstico no acidente vascular encefálico: revisão scoping
DOI:
https://doi.org/10.25758/set.2218Palavras-chave:
Acidente vascular encefálico, Severidade, Prognóstico, Revisão scopingResumo
Introdução – O acidente vascular encefálico (AVE) tem vindo a apresentar uma taxa de incidência estável e um considerável declínio na taxa de mortalidade, o que corresponde a um aumento na prevalência de sobreviventes. O conhecimento das alterações funcionais que podem surgir após o AVE, da sua severidade e das estratégias disponíveis para avaliar a disfunção, facilita a construção de um plano de reabilitação, com objetivos para os profissionais de saúde, para os pacientes e para a família dentro do potencial de recuperação. A severidade surge, como um conceito abrangente associado à presença de deficiências das estruturas, deficiências das funções, limitações das atividades e restrições da participação social. Deficiências, limitações e restrições mais severas fazem prever uma recuperação mais difícil e mais prolongada. A determinação do prognóstico em indivíduos com AVE engloba não só o risco de morte a curto prazo, como também a probabilidade de recuperar a função a longo prazo. Objetivo – Avaliar o panorama acerca da informação existente sobre o nível de severidade e prognóstico em AVE. Métodos – A revisão scoping baseou-se na metodologia de Arksey & O’Malley (2005), sendo constituída por seis passos: 1) identificação da questão; 2) identificação da literatura relevante; 3) seleção da literatura; 4) mapeamento dos dados; 5) recolha, sumário e transcrição dos resultados; 6) consultoria (opcional). Resultados – Foram analisados 47 estudos observacionais. Noventa e cinco por cento dos autores referem-se à severidade como sendo a quantidade de défices neurológicos apresentados pelos indivíduos após o AVE e avaliam-na através de instrumentos de medida específicos para a avaliação de défices neurológicos (76% dos autores utilizaram a NIHSS na sua metodologia). O prognóstico no AVE surge associado à funcionalidade afetada (89%); probabilidade/índice de mortalidade (54%); e encaminhamento após a alta (15%). O prognóstico pode ser influenciado por fatores pessoais e ambientais, fatores clínicos e por algumas comorbilidades, entre outros. Conclusão – Os estudos de severidade e prognóstico em AVE poderão não refletir a condição real do indivíduo e induzir em erro a aplicação destes conceitos na prática clínica, influenciando o prognóstico esperado.
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