Jungehulsing G J, Rossnagel K, Nolte C H, Muller-Nordhorn J, Roll S, Klein M, Wegscheider K, Einhaupl K M, Willich S N, Villringer A
Department of Neurology, Medical School, Charité, Berlin, Germany.
Eur J Neurol. 2006 Mar;13(3):225-32. doi: 10.1111/j.1468-1331.2006.01170.x.
We determined the factors leading to emergency department (ED) delays in patients with acute stroke. Data were collected prospectively in four Berlin inner-city hospitals by ED documentation, medical records, imaging files and patient interviews. An extended Cox proportional hazards model was fitted to the data. Analyses were performed in 558 patients with confirmed diagnosis of stroke. Median time from admission at ED to beginning of computed tomography/magnetic resonance imaging (CT/MRI) was 108 min. In a subgroup of patients potentially eligible for thrombolysis with a pre-hospital delay <120 min and a National Institutes of Health Stroke Scale (NIHSS) >4 (n = 74), the median interval to imaging was 68 min. Multivariable analysis revealed that a more severe initial NIHSS, a pre-hospital delay <3 h, admission at two specific hospitals, admission at weekends, and private health insurance were significantly associated with reduced delays. In stroke patients, the time interval between ED admission and imaging depends both on factors that emerge from clinical needs and on factors independent of clinical necessities. Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for both improvement of in-hospital management and of medical and non-medical factors influencing pre-hospital delays.
我们确定了导致急性中风患者急诊科（ED）延误的因素。通过ED文档、病历、影像文件和患者访谈，前瞻性地收集了柏林市中心四家医院的数据。对数据拟合扩展的Cox比例风险模型。对558例确诊为中风的患者进行了分析。从ED入院到开始计算机断层扫描/磁共振成像（CT/MRI）的中位时间为108分钟。在一组可能符合溶栓条件、院前延误<120分钟且美国国立卫生研究院卒中量表（NIHSS）>4的患者（n = 74）中，成像的中位间隔时间为68分钟。多变量分析显示，初始NIHSS更严重、院前延误<3小时、在两家特定医院入院、周末入院以及私人医疗保险与延误减少显著相关。在中风患者中，ED入院与成像之间的时间间隔既取决于临床需求产生的因素，也取决于与临床必要性无关的因素。考虑到急性中风治疗措施的紧迫性，改善院内管理以及影响院前延误的医疗和非医疗因素既有必要，也有空间。
