Adaptação transcultural da Essen Stroke Risk Score (ESRS) para o Brasil

Abstract

Strokes have affected a large portion of the population, and it is necessary to improve care for patients with such a dysfunction, including the use of instruments that can predict the risk of recurrence of ischemic stroke and death after stroke. Thus, the aim was to carry out the cross-cultural adaptation of the Essen Stroke Risk Score (ESRS) scale for use in Brazil. This methodological study followed recommendations by Beaton et al (2007), encompassing the stages of translation, synthesis, back-translation, content validation, pre-test and application of the Brazilian version of the ESRS in the target population for analysis of predictive validity. In the first four stages, contact with translators and specialists took place via e-mail, and the pre-test and application of Brazilian version of the ESRS in the target population took place at the Fortaleza General Hospital, in the city of Fortaleza, Ceará. The Content Validity Index was verified during content validation, with a cut-off point of 0.8. For analyzing the predictive capacity of the scale, a logistic regression model was built with Pearson's correlation analysis and adjusted risk, and analysis of ROC curves for stroke recurrence and mortality, with p values < 0.05 considered statistically significant. The study followed Resolution 466/12, having been approved by two research ethics committees. The adapted version of the ESRS obtained 100% conceptual equivalence with the original version; it was also considered comprehensible by all health professionals who used it in the pre-test, obtaining an average filling time of 45.8 seconds. The instrument was then applied to 343 patients who had suffered a stroke or transient ischemic attack, all of whom were contacted within the year following their ischemic event. The sample had a mean age of 65.09 ± 15.5 years, 59% of whom were male. The most frequent risk factor was hypertension (75.2%); 55.9% were ≥ 65 years old, 32.7% had previously suffered a stroke or transient ischemic attack, 31.5% had diabetes mellitus, 23% had other cardiovascular diseases and 22.4% were smokers. Stroke recurrence and mortality rates of 14.3% and 16.9%, respectively, were observed within one year after the initial ischemic events. The predictors significantly associated with recurrence of stroke were previous myocardial infarction (p = 0.042) and other cardiovascular diseases (p = 0.001). The risk factors for age > 75 years (p = 0.001), previous myocardial infarction (p = 0.020) and other cardiovascular diseases (p = 0.001) were significant for the occurrence of death. Female patients, thrombolyzed or with previous circulation syndromes were at increased risk for mortality (OR ≥ 1.8). Total cholesterol > 200 mg / dL was a protective factor for outcomes (OR = 0.8). ESRS showed moderate predictive capacity for recurrence of stroke and death (ROC curves: 0.629 and 0.642). Patients with scores > 2 were at higher risk for the observed outcomes (Risk > 1.1), with sensitivity ≈ 74% and specificity ≈ 46%. It is concluded that the adapted version of the ESRS for use in Brazil is adequate to predict stroke recurrence and death after the initial stroke, constituting a tool with the potential to promote cardiovascular health in a variety of care settings.