Leira Enrique C, Hess David C, Torner James C, Adams Harold P
Department of Neurology, 2147-RCP, University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA.
Arch Neurol. 2008 Jul;65(7):887-91. doi: 10.1001/archneur.65.7.887.
Acute stroke management practices in rural areas of the United States are suboptimal, which creates an unacceptable health disparity between urban patients with stroke and their rural counterparts. The existing gap between urban and rural stroke care may widen in the future as more urban-tested interventions are incorporated into the treatment of acute stroke. We conducted a PubMed search to identify all the articles published from 1997 to 2007 that addressed acute stroke, paramedics, ambulances, emergency services, and interhospital transportation pertaining to the US rural, urban, or nonurban environment. We review herein the problems and potential solutions that exist in 3 aspects of the current rural stroke care system: prehospital care, rural local hospital emergency department care, and interhospital transfer of patients and subsequent reception at a larger tertiary care institution, which often involve long distances and considerable time. We conclude that the current gap in rural-urban stroke management practices could be overcome with a comprehensive strategy that addresses the existing issues, including further education of rural caregivers, remote support from tertiary care institutions, and implementation of future acute clinical trials that test the rural strategies to stroke care.
美国农村地区急性中风的管理实践并不理想，这在城市中风患者和农村中风患者之间造成了不可接受的健康差距。随着更多经过城市检验的干预措施被纳入急性中风治疗，城乡中风护理之间现有的差距在未来可能会扩大。我们在PubMed上进行了检索，以识别1997年至2007年发表的所有涉及美国农村、城市或非城市环境下急性中风、护理人员、救护车、紧急服务以及医院间转运的文章。我们在此回顾当前农村中风护理系统三个方面存在的问题和潜在解决方案：院前护理、农村当地医院急诊科护理以及患者的医院间转运和随后在大型三级医疗机构的接收，这些环节往往涉及长距离和相当长的时间。我们得出结论，通过一项全面战略可以克服目前城乡中风管理实践中的差距，该战略应解决现有问题，包括对农村护理人员的进一步培训、三级医疗机构的远程支持以及开展未来急性临床试验以测试农村中风护理策略。
