Turan Tanya N, Hertzberg Vicki, Weiss Paul, McClellan William, Presley Rodney, Krompf Kerrie, Karp Herbert, Frankel Michael R
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Stroke Cerebrovasc Dis. 2005 Nov-Dec;14(6):272-7. doi: 10.1016/j.jstrokecerebrovasdis.2005.07.002.
Identifying characteristics of early arrivers after stroke may be useful to improve delivery of acute stroke treatment. We sought to identify the clinical characteristics and outcomes of patients with ischemic stroke who present early after symptom onset using data collected from a representative sample of hospitals in the state of Georgia.
Data were obtained retrospectively from a statewide observational stroke registry from December 1, 2001, to February 28, 2002, and from February 1 to March 31, 2003. Clinical characteristics of patients with stroke arriving to the hospital within 2 hours were compared with those arriving later.
Of the 409 patients with ischemic stroke identified with a specified time of onset, 172 (42%) presented within 2 hours. Univariate analysis showed hospital arrival within 2 hours was associated with history of coronary artery disease (P = .0400), dyslipidemia (P = .0100), ambulance transport (P = .0285), stroke team consultation (P = .0070), higher National Institutes of Health Stroke Scale score (P < .0001), and lower Glasgow Coma Scale score (P = .0018). Race, sex, age, smoking history, previous stroke, myocardial infarction, congestive heart failure, prosthetic heart valve, hypertension, diabetes, and family history of stroke were not associated with arrival within 2 hours. Multivariate analysis revealed National Institutes of Health Stroke Scale score (odds ratio = 1.20, confidence interval 1.08-1.34, P = .0013) and Glasgow Coma Scale score (odds ratio = 0.84, confidence interval 0.75-0.94, P = .0027) were associated with arrival within 2 hours. Patients with stroke arriving within 2 hours had higher in-hospital mortality (13% v 4%) (P = .0284), but a higher rate of independent ambulation at discharge (55% v 37%) (P = .0419).
Early arrival after ischemic stroke symptom onset is associated with increased stroke severity, higher mortality, and better functional outcome.
识别卒中后早期就诊患者的特征可能有助于改善急性卒中治疗的实施。我们试图利用从佐治亚州具有代表性的医院样本收集的数据，确定症状发作后早期就诊的缺血性卒中患者的临床特征和预后。
数据回顾性地取自2001年12月1日至2002年2月28日以及2003年2月1日至3月31日的全州卒中观察登记处。将发病2小时内到达医院的卒中患者的临床特征与之后到达的患者进行比较。
在409例确定了特定发病时间的缺血性卒中患者中，172例（42%）在2小时内就诊。单因素分析显示，2小时内到达医院与冠状动脉疾病史（P = 0.0400）、血脂异常（P = 0.0100）、救护车转运（P = 0.0285）、卒中团队会诊（P = 0.0070）、较高的美国国立卫生研究院卒中量表评分（P < 0.0001）以及较低的格拉斯哥昏迷量表评分（P = 0.0018）相关。种族、性别、年龄、吸烟史、既往卒中、心肌梗死、充血性心力衰竭、人工心脏瓣膜、高血压、糖尿病和卒中家族史与2小时内到达无关。多因素分析显示，美国国立卫生研究院卒中量表评分（比值比 = 1.20，置信区间1.08 - 1.34，P = 0.0013）和格拉斯哥昏迷量表评分（比值比 = 0.84，置信区间0.75 - 0.94，P = 0.0027）与2小时内到达相关。2小时内到达的卒中患者院内死亡率较高（13%对4%）（P = 0.0284），但出院时独立行走率较高（55%对37%）（P = 0.0419）。
缺血性卒中症状发作后早期到达与卒中严重程度增加、死亡率较高和功能预后较好相关。
