Dulli Douglas, Samaniego Edgar A
University of Wisconsin Hospital and Clinics, Madison, WI, USA.
Neuroepidemiology. 2007;28(2):86-92. doi: 10.1159/000098551. Epub 2007 Jan 17.
Previous studies have shown that inpatient strokes are common and severe. We sought to characterize the risk factors, stroke subtypes, timing of acute stroke evaluation and frequency of thrombolytic therapy in inpatient ischemic strokes compared with community ischemic strokes.
DESIGN/METHODS: The hospital records of patients admitted for acute ischemic stroke between 1996 and 2002 were reviewed. Acute stroke was defined as occurrence of stroke symptoms within 72 h, and in-hospital status was assigned if the patient was currently admitted for another illness at the time of the stroke. Patient demographics such as medical versus surgical service, admission diagnoses, clinical features including stroke risk factors, access to thrombolytic therapy and immediate outcome were analyzed.
Of 947 patients with acute ischemic stroke, 161 (17.0%) had strokes occurring while already in the hospital (IHIS), compared to 786 (83%) that occurred in the outpatient community (CIS). Approximately two thirds of IHIS occurred on medical services (102, 63.4%) and one third on surgical services (59, 36.7%). Mean age, male gender, atherothrombotic etiology and risk factors including hypertension, diabetes and smoking history were of similar frequencies in IHIS and CIS, but penetrating artery disease was the cause of only 5.6% of IHIS compared to 21.8% of CIS (p<0.0001). The mean modified Rankin scale for IHIS at presentation was 4.33 +/- 0.74, compared to 3.67 +/- 1.03 for CIS (p<0.0001). Of 161 IHIS patients, 21 (13.0%) had neurological assessment within 3 h of symptom onset, compared to 16.0% of CIS patients (p=0.403, n.s.), and the rate of thrombolytic therapy was not significant between IHIS (3.7%) and CIS (5.6%) patients.
IHIS are common and severer than CIS. The use of thrombolytic therapy in IHIS patients was limited because of time of recognition and inpatient-associated conditions. Increased vigilance for timely neurological assessment of these patients is warranted.
既往研究表明，住院患者发生的中风常见且严重。我们试图比较住院缺血性中风与社区缺血性中风的危险因素、中风亚型、急性中风评估时机及溶栓治疗频率。
设计/方法：回顾了1996年至2002年期间因急性缺血性中风入院患者的医院记录。急性中风定义为中风症状在72小时内出现，若患者在中风时因其他疾病正在住院，则确定其住院状态。分析患者人口统计学特征，如医疗服务与外科服务、入院诊断、临床特征（包括中风危险因素）、溶栓治疗情况及即刻预后。
947例急性缺血性中风患者中，161例（17.0%）在住院期间发生中风（住院缺血性中风，IHIS），786例（83%）在门诊社区发生中风（社区缺血性中风，CIS）。约三分之二的IHIS发生在医疗科室（102例，63.4%），三分之一发生在外科科室（59例，36.7%）。IHIS和CIS患者的平均年龄、男性比例、动脉粥样硬化血栓形成病因及包括高血压、糖尿病和吸烟史在内的危险因素频率相似，但穿支动脉疾病仅导致5.6%的IHIS，而导致21.8%的CIS（p<0.0001）。IHIS患者入院时改良Rankin量表平均评分为4.33±0.74，CIS患者为3.67±1.03（p<0.0001）。161例IHIS患者中，21例（13.0%）在症状发作后3小时内接受了神经学评估，CIS患者为16.0%（p=0.403，无统计学意义），IHIS患者（3.7%）和CIS患者（5.6%）的溶栓治疗率无显著差异。
IHIS常见且比CIS更严重。由于识别时间及与住院相关的情况，IHIS患者溶栓治疗的应用有限。有必要提高对这些患者及时进行神经学评估的警惕性。
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