King's College London, Division of Health and Social Care Research, London, UK.
BMJ. 2011 Feb 24;342:d744. doi: 10.1136/bmj.d744.
To investigate time trends in receipt of effective acute stroke care and to determine the factors associated with provision of care.
Population based stroke register.
South London.
3800 patients with first ever ischaemic stroke or primary intracerebral haemorrhage registered between January 1995 and December 2009.
Acute care interventions, admission to hospital, care on a stroke unit, acute drugs, and inequalities in access to care.
Between 2007 and 2009, 5% (33/620) of patients were still not admitted to a hospital after an acute stroke, particularly those with milder strokes, and 21% (124/584) of patients admitted to hospital were not admitted to a stroke unit. Rates of admission to stroke units and brain imaging, between 1995 and 2009, and for thrombolysis, between 2005 and 2009, increased significantly (P<0.001). Black patients compared with white patients had a significantly increased odds of admission to a stroke unit (odds ratio 1.76, 95% confidence interval 1.35 to 2.29, P<0.001) and of receipt of occupational therapy or physiotherapy (1.90, 1.21 to 2.97, P=0.01), independent of age or stroke severity. Patients with motor or swallowing deficits were also more likely to be admitted to a stroke unit (1.52, 1.12 to 2.06, P=0.001 and 1.32, 1.02 to 1.72, P<0.001, respectively). Length of stay in hospital decreased significantly between 1995 and 2009 (P<0.001). The odds of brain imaging were lowest in patients aged 75 or more years (P=0.004) and those of lower socioeconomic status (P<0.001). The likelihood of those with a functional deficit receiving rehabilitation increased significantly over time (P<0.001). Patients aged 75 or more were more likely to receive occupational therapy or physiotherapy (P=0.002).
Although the receipt of effective acute stroke care improved between 1995 and 2009, inequalities in its provision were significant, and implementation of evidence based care was not optimal.
研究接受有效急性脑卒中治疗的时间趋势，并确定与治疗相关的因素。
基于人群的脑卒中登记。
伦敦南部。
1995 年 1 月至 2009 年 12 月期间登记的首次缺血性脑卒中或原发性脑出血的 3800 例患者。
急性治疗干预、住院、入住脑卒中单元、急性药物治疗以及获得治疗的差异。
2007 年至 2009 年间，5%（33/620）的患者在急性脑卒中后仍未住院，特别是那些病情较轻的患者，而 124/584 例住院患者未入住脑卒中单元。1995 年至 2009 年期间，住院率和脑影像学检查以及 2005 年至 2009 年期间的溶栓治疗率显著增加（P<0.001）。与白人患者相比，黑人患者入住脑卒中单元的可能性显著增加（比值比 1.76，95%置信区间 1.35 至 2.29，P<0.001），并且接受职业治疗或物理治疗的可能性也更高（1.90，1.21 至 2.97，P=0.01），这与年龄或脑卒中严重程度无关。有运动或吞咽障碍的患者也更有可能入住脑卒中单元（1.52，1.12 至 2.06，P=0.001 和 1.32，1.02 至 1.72，P<0.001）。1995 年至 2009 年间，住院时间显著缩短（P<0.001）。75 岁及以上患者（P=0.004）和社会经济地位较低的患者（P<0.001）进行脑部影像学检查的可能性最低。有功能缺陷的患者接受康复治疗的可能性随着时间的推移显著增加（P<0.001）。75 岁及以上的患者更有可能接受职业治疗或物理治疗（P=0.002）。
尽管 1995 年至 2009 年间急性脑卒中治疗的效果有所改善，但提供治疗的差异仍然显著，且循证治疗的实施并不理想。
