Rose Kathryn M, Rosamond Wayne D, Huston Sara L, Murphy Carol V, Tegeler Charles H
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
Stroke. 2008 Dec;39(12):3262-7. doi: 10.1161/STROKEAHA.108.524686. Epub 2008 Aug 7.
We examined patient demographic and hospital characteristics and clinical predictors of delay time from hospital arrival until CT among 20 374 patients enrolled in the North Carolina Collaborative Stroke Registry (January 2005 to April 2008).
Delay time was log-transformed in linear regression analyses and dichotomized (<or=25 minutes, >25 minutes) in logistic regression analyses to correspond to a 1999 National Institute of Neurological Disorders and Stroke guideline.
In multiple linear regression analyses, prehospital delay time, mode of transport, race, gender, presumptive diagnosis, time of day of arrival, weekday versus weekend arrival, and hospital type (defined by Joint Commission Primary Stroke Center certification and teaching status) were significantly associated with CT delay. In analyses of 3549 patients arriving within 2 hours of symptom onset, time of day of arrival and weekday versus weekend arrival were no longer significant. Among patients arriving within 2 hours of symptom onset, the strongest independent predictors of meeting the National Institute of Neurological Disorders and Stroke (NINDS) guideline were arrival by emergency medical services versus other modes of transportation (odds ratio, 95% CI=2.3 [1.9, 2.8]) and a presumptive diagnosis of transient ischemic attack versus unspecified stroke type (odds ratio, 95% CI=0.4 [0.3, 0.5]).
Most patients do not arrive to the hospital in a timely manner and cannot be considered for time-dependent therapies. Among those that do, disparities exist in time to receipt of CT scan, suggesting room for improvement in hospital-level stroke systems of care.
我们研究了20374名纳入北卡罗来纳州卒中协作登记系统（2005年1月至2008年4月）的患者的人口统计学特征、医院特征以及从入院到进行CT检查的延迟时间的临床预测因素。
在线性回归分析中对延迟时间进行对数转换，在逻辑回归分析中进行二分法分类（≤25分钟，>25分钟），以符合1999年美国国立神经疾病和卒中研究所的指南。
在多元线性回归分析中，院前延迟时间、运输方式（交通工具）、种族、性别、初步诊断、到达时间、工作日与周末到达情况以及医院类型（由联合委员会初级卒中中心认证和教学状况定义）与CT延迟显著相关。在对症状发作后2小时内到达的3549名患者的分析中，到达时间和工作日与周末到达情况不再具有显著性。在症状发作后2小时内到达的患者中，符合美国国立神经疾病和卒中研究所（NINDS）指南的最强独立预测因素是通过紧急医疗服务到达而非其他运输方式（比值比，95%可信区间=2.3[1.9,2.8]）以及初步诊断为短暂性脑缺血发作而非未明确的卒中类型（比值比，95%可信区间=0.4[0.3,0.5]）。
大多数患者没有及时到达医院，无法考虑进行时间依赖性治疗。在那些及时到达的患者中，接受CT扫描的时间存在差异，这表明医院层面的卒中护理系统仍有改进空间。
