Kleindorfer Dawn O, Lindsell Christopher J, Broderick Joseph P, Flaherty Matthew L, Woo Daniel, Ewing Irene, Schmit Pam, Moomaw Charles, Alwell Kathleen, Pancioli Arthur, Jauch Edward, Khoury Jane, Miller Rosie, Schneider Alexander, Kissela Brett M
Department of Neurology, The Institute for the Study of Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0525, USA.
Stroke. 2006 Jun;37(6):1508-13. doi: 10.1161/01.STR.0000222933.94460.dd. Epub 2006 May 11.
Timely access to medical treatment is critical for patients with acute stroke because acute therapies must be given very quickly after symptom onset. We examined the effect of socioeconomic status on prehospital delays in stroke and transient ischemic attack (TIA) patients within a large, biracial population.
By screening all local hospital ICD-9 codes 430 to 436, all stroke and TIA patients were identified during the calendar year of 1999. Cases must have used emergency medical services (EMS), lived at home, had their stroke at home, and had documented times of the 911 call and arrival to the emergency department. Socioeconomic status was estimated using economic data regarding the geocoded home residence census tract.
Only 38% of stroke and TIA patients used EMS. There were 978 cases of stroke and TIA included in this analysis. The mean times were call to arrival on scene 6.5 minutes, on-scene time 14.1 minutes, and transport time 13.1 minutes. Lower community socioeconomic status was associated with all 3 EMS time intervals; however, all time differences were small: the largest difference was 5 minutes.
Within our population, living in a poorer area does not appear to delay access to acute care for stroke in a clinically significant way. We did find small, statistically significant delays in prehospital times that were associated with poorer communities, black race, and increasing age. However, delays related to public recognition of stroke symptoms, and limited use of 911, are likely much more important than these small delays that occur with EMS systems.
对于急性中风患者而言，及时获得医疗救治至关重要，因为急性治疗必须在症状出现后尽快进行。我们在一个大型的双种族人群中，研究了社会经济地位对中风和短暂性脑缺血发作（TIA）患者院前延误的影响。
通过筛查所有当地医院国际疾病分类第九版（ICD - 9）编码430至436，在1999年日历年期间识别出所有中风和TIA患者。病例必须使用过紧急医疗服务（EMS），居住在家中，在家中发生中风，并且有911呼叫时间和到达急诊科时间的记录。使用关于地理编码家庭居住普查区的经济数据来估计社会经济地位。
只有38%的中风和TIA患者使用了EMS。本分析纳入了978例中风和TIA病例。平均时间为：呼叫至到达现场6.5分钟，现场时间14.1分钟，转运时间13.1分钟。社区社会经济地位较低与所有3个EMS时间间隔相关；然而，所有时间差异都很小：最大差异为5分钟。
在我们的人群中，生活在较贫困地区似乎并不会以临床上显著的方式延迟中风患者获得急性护理。我们确实发现院前时间存在小的、具有统计学意义的延误，这些延误与较贫困社区、黑人种族和年龄增长有关。然而，与公众对中风症状的认知以及911使用有限相关的延误，可能比EMS系统出现的这些小延误重要得多。
