大量的脑卒中医生应该用于治疗大量的接受 IV rt-PA 治疗的脑卒中患者。

Large numbers of stroke physicians should be used to treat large numbers of stroke patients with IV rt-PA.

机构信息

Department of Stroke Medicine, Kawasaki Medical School, Japan.

出版信息

J Neurol Sci. 2011 Mar 15;302(1-2):81-4. doi: 10.1016/j.jns.2010.11.020. Epub 2010 Dec 30.

DOI:10.1016/j.jns.2010.11.020

PMID:21195435

Abstract

PURPOSE

Our aim was to investigate the relationship between number of stroke physicians (SPs) and number of patients treated with intravenous thrombolysis (IV rt-PA) per year.

METHODS

Questionnaires about the infrastructure of acute stroke care including number of SPs and patients given IV rt-PA from October 2008 to September 2009 were sent to 3877 hospitals in Japan. We compared the number of SPs between: 1) hospitals not giving IV rt-PA for a year vs. hospitals giving IV rt-PA for ≥ 1 patient; 2) ≤ 5 vs. >5 patients; 3) ≤ 10 vs. >10 patients; and 4) ≤ 25 vs. >25 patients. We established cut-off numbers of SPs administering IV rt-PA for ≥ 1, >5, >10, and >25 patients/hospital/year using a sensitivity-specificity curve.

RESULTS

Responses were received from 2488 of the 3877 hospitals (64.2%), and 919 hospitals admitted acute stroke patients. Of these, 385 hospitals were not administering IV rt-PA in that year, 250 hospitals gave IV rt-PA for 1-4 patients, 131 hospitals for 5-9 patients, 102 hospitals for 10-25 patients, and 30 hospitals for >25 patients. Cut-off numbers of SPs per hospital were 1 doctor administering IV rt-PA for ≥ 1 patient/year (sensitivity, 83.8%; specificity, 84.5%), 2 doctors for >5 patients (sensitivity, 85.9%; specificity, 74.1%), 3 doctors for >10 patients (sensitivity, 76.3%; specificity, 75.5%), and 4 doctors for >25 patients (sensitivity, 86.2%; specificity, 78.5%). An independent factor for IV rt-PA with >25 patients was ≥ 4 SPs (odds ratio, 3.83; 95% confidence interval, 1.17-12.63; p=0.027).

CONCLUSIONS

Higher numbers of SPs should be associated with higher numbers of patients getting IV rt-PA.

摘要

目的

本研究旨在探讨每年接受静脉溶栓治疗（IV rt-PA）的患者数量与卒中医生数量之间的关系。

方法

2008 年 10 月至 2009 年 9 月，我们向日本 3877 家医院发放了有关急性卒中治疗基础设施的调查问卷，内容包括卒中医生人数和 IV rt-PA 治疗患者人数。我们比较了以下医院之间的卒中医生人数：1）未进行 IV rt-PA 治疗的医院与进行了 IV rt-PA 治疗≥1 例的医院；2）≤5 例与>5 例；3）≤10 例与>10 例；4）≤25 例与>25 例。我们使用灵敏度特异性曲线确定了每个医院每年进行 IV rt-PA 治疗≥1、>5、>10 和>25 例的卒中医生数量的截止值。

结果

3877 家医院中，2488 家（64.2%）做出了回应，919 家医院收治了急性卒中患者。其中，385 家医院当年未进行 IV rt-PA 治疗，250 家医院为 1-4 例患者进行 IV rt-PA 治疗，131 家医院为 5-9 例患者，102 家医院为 10-25 例患者，30 家医院为>25 例患者。每家医院进行 IV rt-PA 治疗的卒中医生人数的截止值分别为：1 名医生治疗≥1 例/年（灵敏度，83.8%；特异性，84.5%），2 名医生治疗>5 例（灵敏度，85.9%；特异性，74.1%），3 名医生治疗>10 例（灵敏度，76.3%；特异性，75.5%），4 名医生治疗>25 例（灵敏度，86.2%；特异性，78.5%）。IV rt-PA 治疗>25 例患者的独立因素为≥4 名卒中医生（优势比，3.83；95%置信区间，1.17-12.63；p=0.027）。