Schumacher H Christian, Bateman Brian T, Boden-Albala Bernadette, Berman Mitchell F, Mohr J P, Sacco Ralph L, Pile-Spellman John
Doris and Stanley Tananbaum Stroke Center, Neurological Institute, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Ann Emerg Med. 2007 Aug;50(2):99-107. doi: 10.1016/j.annemergmed.2007.01.021. Epub 2007 May 3.
The aim of this study is to characterize hospital and patient characteristics associated with administration of thrombolysis in acute ischemic stroke patients in the United States.
This retrospective, observational, cohort study used data from the Nationwide Inpatient Sample, an administrative discharge database. A total of 366,194 hospitalizations admitted through the emergency department with a primary diagnosis of acute ischemic stroke were selected for analysis. The primary outcome considered in this study is whether the patient received thrombolytic therapy on hospital day 0 or 1.
Thrombolysis was used in 1.12% (95% confidence interval [CI] 0.95% to 1.32%) of ischemic stroke hospitalizations. Most hospitals (69.5%; 95% CI 68.4% to 70.6%) treating ischemic stroke patients did not use thrombolysis during the study period. For the hospitals that used thrombolysis, the mean annual number of patients treated with thrombolysis per hospital was 3.06 (95% CI 2.68 to 3.44). In the binary logistic regression analysis, hospital characteristics associated with high use of thrombolysis were teaching hospital status and increasing number of stroke patients treated annually. Patient characteristics associated with higher use of thrombolysis were age younger than 55 years, male sex, and low comorbidity as measured by the modified Charlson Index; white race; and private self-pay health insurance.
Use of thrombolysis for ischemic stroke in the United States from 1999 to 2004 was infrequent and showed significant differences, depending on hospital and patient demographic characteristics.
本研究旨在描述美国急性缺血性卒中患者接受溶栓治疗相关的医院和患者特征。
这项回顾性观察性队列研究使用了来自全国住院患者样本（一个行政出院数据库）的数据。共选取了366194例通过急诊科收治且主要诊断为急性缺血性卒中的住院病例进行分析。本研究考虑的主要结局是患者在住院第0天或第1天是否接受了溶栓治疗。
1.12%（95%置信区间[CI]0.95%至1.32%）的缺血性卒中住院病例使用了溶栓治疗。在研究期间，大多数治疗缺血性卒中患者的医院（69.5%；95%CI68.4%至70.6%）未使用溶栓治疗。对于使用溶栓治疗的医院，每家医院每年接受溶栓治疗的患者平均数量为3.06例（95%CI2.68至3.44）。在二元逻辑回归分析中，与高溶栓治疗使用率相关的医院特征是教学医院地位以及每年治疗的卒中患者数量增加。与较高溶栓治疗使用率相关的患者特征是年龄小于55岁、男性、改良Charlson指数所衡量的低合并症；白人种族；以及私人自费医疗保险。
1999年至2004年美国缺血性卒中溶栓治疗的使用频率较低，且根据医院和患者人口统计学特征存在显著差异。
