Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA.
Stroke. 2009 Dec;40(12):3845-50. doi: 10.1161/STROKEAHA.109.562660. Epub 2009 Oct 1.
Prompt care-seeking behavior is a focus of US national public stroke educational campaigns. We determined whether the time between symptom onset and hospital arrival and the receipt of intravenous tissue-type plasminogen activator (IV t-PA) changed for ischemic stroke patients evaluated at US academic centers between 2001 and 2004.
Medical records were abstracted for consecutive ischemic stroke patients admitted from the Emergency Department within 48 hours of symptom onset at 35 academic medical centers participating in the University HealthSystem Consortium Ischemic Stroke Benchmarking Project between January 1, 2001 and March 31, 2001, and 32 centers between January 1, 2004 and June 30, 2004. Demographic and clinical characteristics of patients who presented within and after 2 hours of symptom onset were compared. Multivariate logistic regression was used to compare time to arrival by year and to identify patient characteristics associated with earlier hospital arrival.
The study included 428 patients from 2001 and 481 from 2004. Although there was no difference in the percentage of patients who arrived within 2 hours between the 2 periods (37% in 2001 vs 38% in 2004, P=0.63), the percentage of these patients treated with IV t-PA increased (14.0% to 37.5%, P<0.0001). In risk-adjusted analysis, black patients had a lower odds of arriving within 2 hours (odds ratio=0.55; 95% CI, 0.39 to 0.78), whereas those with severe strokes were more likely to arrive promptly (odds ratio=2.17; 95% CI, 1.49 to 3.15).
There was no change in the proportion of stroke patients arriving at hospitals within 2 hours of symptom onset between 2001 and 2004; however, the rate of IV t-PA use increased, indicating system-level improvements of in-hospital care.
及时寻求治疗是美国国家公众脑卒中教育活动的重点。我们确定了在 2001 年至 2004 年间，在美国学术中心接受评估的缺血性脑卒中患者，其从症状发作到医院就诊的时间以及接受静脉内组织型纤溶酶原激活剂（IV t-PA）治疗的时间是否发生了变化。
从参加大学健康联盟缺血性脑卒中基准项目的 35 家学术医疗中心的急诊部在症状发作后 48 小时内连续收治的连续缺血性脑卒中患者的病历中提取数据，该项目的时间为 2001 年 1 月 1 日至 2001 年 3 月 31 日；从 2004 年 1 月 1 日至 2004 年 6 月 30 日，在 32 个中心进行了数据提取。比较了在症状发作后 2 小时内和之后就诊的患者的人口统计学和临床特征。使用多元逻辑回归比较了每年到达的时间，并确定了与更早到达医院相关的患者特征。
本研究纳入了 2001 年的 428 例患者和 2004 年的 481 例患者。尽管两个时期内到达 2 小时内的患者比例没有差异（2001 年为 37%，2004 年为 38%，P=0.63），但接受 IV t-PA 治疗的患者比例有所增加（14.0%至 37.5%，P<0.0001）。在风险调整分析中，黑人患者在 2 小时内到达的可能性较低（比值比=0.55；95%置信区间，0.39 至 0.78），而脑卒中严重的患者更有可能及时到达（比值比=2.17；95%置信区间，1.49 至 3.15）。
在 2001 年至 2004 年期间，到达医院的症状发作后 2 小时内的脑卒中患者比例没有变化；然而，IV t-PA 的使用率有所增加，表明院内护理的系统水平有所提高。
