Kwon Young-Dae, Yoon Sung Sang, Chang Hyejung
Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Korea.
J Prev Med Public Health. 2007 Mar;40(2):130-6. doi: 10.3961/jpmph.2007.40.2.130.
Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke.
A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval between symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes.
Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital.
The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.
近期的教育工作集中在症状出现后患者尽早到达医院。本研究的目的是评估症状出现至到达医院的时间间隔，并调查其与急性缺血性卒中患者临床结局的关系。
2003年9月至2004年12月，建立了一个前瞻性登记系统，登记通过急诊室入住OO医疗中心的急性缺血性卒中体征或症状患者。记录每位符合条件患者症状出现至到达医院的时间间隔，并与临床特征、用药类型、神经功能缺损严重程度和功能结局一起进行分析。
基于256例患者的数据，症状出现至到达医院的中位时间间隔为13小时，22%的患者在症状出现后3小时内入院。初始病情不轻度和功能状态的患者在出院时的功能结局方面，0至3小时到达与3小时后到达存在显著差异。逻辑回归模型还显示，除了患者的初始严重程度、老年、心源性栓塞亚型和转诊至其他医院外，3小时内到达是影响功能结局的一个重要因素（OR = 5.6；95% CI = 2.1，15.0）。
即使在控制了其他重要临床特征后，症状出现至到达医院的时间间隔仍显著影响急性缺血性卒中患者的治疗结局。这些发现为患者尽早到达医院和改善急诊医疗系统提供了依据。
