Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Room 1654H ML 0769, Cincinnati, OH 45267-0769, USA.
Neurocrit Care. 2012 Apr;16(2):232-40. doi: 10.1007/s12028-011-9644-2.
Neurocritical care provides multidisciplinary, specialized care to critically ill neurological patients, yet an understanding of the proportion of the population able to rapidly access specialized Neurocritical Care Units (NCUs) in the United States is currently unknown. We sought to quantify geographic access to NCUs by state, division, region, and for the US as a whole. In addition, we examined how mode of transportation (ground or air ambulance), and prehospital transport times affected population access to NCUs.
Data were obtained from the Neurocritical Care Society (NCS), US Census Bureau and the Atlas and Database of Air Medical Services. Empirically derived prehospital time intervals and validated models estimating prehospital ground and air travel times were used to calculate total prehospital times. A discrete total prehospital time interval was calculated for each small unit of geographic analysis (block group) and block group populations were summed to determine the proportion of Americans able to reach a NCU within discrete time intervals (45, 60, 75, and 90 min). Results are presented for different geographies and for different modes of prehospital transport (ground or air ambulance).
There are 73 NCUs in the US using ground transportation alone, 12.8, 20.5, 27.4, and 32.6% of the US population are within 45, 60, 75, and 90 min of an NCU, respectively. Use of air ambulances increases access to 36.8, 50.4, 60, and 67.3 within 45, 60, 75, and 90 min, respectively. The Northeast has the highest access rates in the US using ground ambulances and for 45, 60, and 75 min transport times with the addition of air ambulances. At 90 min, the West has the highest access rate. The Southern region has the lowest ground and air access to NCUs access rates for all transport times.
Using NCUs registered with the NCS, current geographic access to NCUs is limited in the US, and geographic disparities in access to care exist. While additional NCUs may exist beyond those identified by the NCS database, we identify geographies with limited access to NCUs and offer a population-based planning perspective on the further development of the US neurocritical care system.
神经重症监护为重症神经疾病患者提供多学科、专业化的治疗，但目前尚不清楚美国有多少人能够迅速获得神经重症监护病房（NCU）的专业治疗。我们旨在按州、区、地区和美国整体来量化各州获得 NCU 的地理条件。此外，我们还研究了运输方式（地面或空中救护车）和院前转运时间如何影响人群获得 NCU 的机会。
数据来自神经重症监护学会（NCS）、美国人口普查局和空中医疗服务地图集与数据库。使用经验衍生的院前时间间隔和经验证的模型来估算院前地面和空中旅行时间，以计算总院前时间。为每个小的地理分析单位（街区组）计算离散的总院前时间间隔，并将街区组的人口相加，以确定在离散时间间隔（45、60、75 和 90 分钟）内能够到达 NCU 的美国人比例。结果按不同地理位置和不同的院前运输方式（地面或空中救护车）呈现。
美国有 73 家 NCU 仅使用地面交通工具，分别有 12.8%、20.5%、27.4%和 32.6%的美国人在 45、60、75 和 90 分钟内可以到达 NCU。使用空中救护车可分别增加 36.8%、50.4%、60%和 67.3%的人群在 45、60、75 和 90 分钟内到达 NCU。东北地区使用地面救护车和 45、60 和 75 分钟的运输时间时，具有最高的到达率，而加上空中救护车后，西部地区的到达率最高。在 90 分钟时，南部地区到达 NCU 的地面和空中交通工具的机会最少。
使用 NCS 注册的 NCU，目前美国获得 NCU 的地理条件有限，存在获得护理的地理差异。虽然 NCS 数据库之外可能还有其他的 NCU，但我们确定了获得 NCU 机会有限的地区，并从人口角度为美国神经重症监护系统的进一步发展提供了规划视角。
