Sharma Jagdish, Fletcher Sally, Vassallo Michael, Butcher Clive, Ross Ian
King's Mill Hospital, Sutton in Ashfield, UK.
Gerontology. 2002 Sep-Oct;48(5):321-4. doi: 10.1159/000065257.
It is desirable that all acute stroke patients are investigated with a computerised tomography (CT) scan, but there may be situations when this is not possible.
To investigate the characteristics and outcome of acute stroke patients not investigated with a CT scan and whether 'not performing a CT scan' influences mortality.
Consecutive acute stroke patients admitted to a general hospital were studied for baseline characteristics, previous stroke, pre-stroke Rankin score, post-stroke neurological details, functional disability, complications and acute phase and 3-month mortality. Patients were categorised into two groups depending on whether or not they were investigated with a CT scan. chi(2) and regression analysis were performed to study characteristics and mortality.
Ninety-four of the 296 patients did not undergo investigation with a CT scan. These patients were older (p = 0.001), had suffered previous strokes and had a poorer general health prior to admission (p < 0.001). Although there was no difference in clinical stroke syndromes and immediate post-stroke functional impairment, they had a greater impairment of level of consciousness (p = 0.003) and had a higher acute phase and 3-month mortality (p = 0.001). Not being investigated with a CT scan had an adverse influence on 3-month mortality independent of other variables.
Whilst not investigating with a CT scan in acute stroke patients carries a poor prognosis, a group of patients may be managed without this investigation because of their poor pre-existing general health. These facts may be considered when preparing local guidelines for brain imaging for acute stroke patients.
理想情况下，所有急性中风患者都应接受计算机断层扫描（CT）检查，但在某些情况下可能无法进行。
研究未接受CT扫描的急性中风患者的特征和预后，以及“未进行CT扫描”是否会影响死亡率。
对一家综合医院收治的连续急性中风患者进行研究，记录其基线特征、既往中风史、中风前Rankin评分、中风后神经学细节、功能残疾情况、并发症以及急性期和3个月死亡率。根据患者是否接受CT扫描将其分为两组。采用卡方检验和回归分析来研究特征和死亡率。
296例患者中有94例未接受CT扫描。这些患者年龄较大（p = 0.001），有过中风史，入院前总体健康状况较差（p < 0.001）。尽管临床中风综合征和中风后即刻功能障碍无差异，但他们的意识水平受损更严重（p = 0.003），急性期和3个月死亡率更高（p = 0.001）。未接受CT扫描对3个月死亡率有不利影响，且独立于其他变量。
虽然对急性中风患者不进行CT扫描预后较差，但由于部分患者入院前总体健康状况不佳，可能无需此项检查即可进行治疗。在制定急性中风患者脑部成像的当地指南时，可考虑这些因素。
