Brown D L, Lisabeth L D, Garcia N M, Smith M A, Morgenstern L B
Stroke Program, University of Michigan ,Health System, Ann Arbor, USA.
Neurology. 2004 Dec 28;63(12):2250-4. doi: 10.1212/01.wnl.0000147292.64051.9b.
To identify demographic and clinical variables of emergency department (ED) practices in a community-based acute stroke study.
By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus Christi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regression, variables independently associated with three separate outcomes were sought: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation variables. Percentage use of recombinant tissue plasminogen activator (rt-PA) was calculated.
A total of 941 Mexican Americans (MAs) and 855 non-Hispanic whites (NHWs) were seen for ischemic stroke (66%) or TIA (34%). Only 8% of patients received an in-person neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology consultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.81]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA.
Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.
在一项基于社区的急性卒中研究中，确定急诊科（ED）诊疗的人口统计学和临床变量。
作为科珀斯克里斯蒂脑卒中标本监测（BASIC）项目的一部分，作者通过主动和被动监测，在得克萨斯州努埃塞斯县确定了脑血管疾病病例，该项目是一项基于人群的卒中监测研究，时间跨度为2000年1月1日至2002年12月31日。使用多变量逻辑回归，寻找与三个不同结局独立相关的变量：住院、在急诊科进行脑部成像以及在急诊科接受神经科医生会诊。预先设定的变量包括年龄、性别、种族、保险状况、美国国立卫生研究院卒中量表评分、卒中类型（缺血性卒中或短暂性脑缺血发作[TIA]）、血管危险因素以及症状表现变量。计算重组组织型纤溶酶原激活剂（rt-PA）的使用百分比。
共有941名墨西哥裔美国人（MA）和855名非西班牙裔白人（NHW）因缺血性卒中（66%）或TIA（34%）前来就诊。只有8%的患者在急诊科接受了面对面的神经科会诊，12%的患者未接受任何头部成像检查。与完全性卒中相比，TIA与神经科会诊呈负相关（优势比[OR]0.35[95%可信区间0.21至0.57]）。TIA（OR 0.14[0.10至0.19]）和感觉症状（OR 0.59[0.44至0.81]）也与住院呈负相关。MA在急诊科接受神经科会诊的可能性低于NHW（OR 0.58[0.35至0.98]）。只有1.7%的患者接受了rt-PA治疗。
神经科医生很少参与急诊科的急性脑血管疾病治疗，尤其是TIA患者。神经科医生更多地参与可能会改善急诊科的急性卒中诊断和治疗工作。
