University of Connecticut School of Medicine, Farmington, CT, USA.
Stroke. 2012 Apr;43(4):1067-74. doi: 10.1161/STROKEAHA.111.643437. Epub 2012 Jan 26.
In-hospital mortality is higher for certain medical conditions based on the time of presentation to the emergency department. The primary goal of this study was to determine whether patients with acute ischemic stroke who arrived to the emergency department during a nursing shift change had similar rates of thrombolytic use and functional outcomes compared with patients presenting during nonshift change hours.
A retrospective review of patients with acute ischemic stroke presenting to the emergency department of a primary stroke center from 2005 through 2010. The time to notify the stroke team, perform a head CT scan, and to start intravenous or intra-arterial thrombolysis was assessed. Thrombolysis rates, mortality rate, discharge disposition, change in the National Institutes of Health Stroke Scale, and change in modified Barthel Index at 3 and 12 months were assessed.
Of 3133 patients with acute ischemic stroke, 917 met criteria for inclusion. Arrival during nursing shift change, weekends, and July through September had no impact on process times, thrombolysis rates, and functional outcomes. Arrival at night did result in longer time to intra-arterial but not to intravenous thrombolysis, higher mortality rate, and smaller gain in functional status as measured by the modified Barthel Index at 3 months. The degree of emergency department "busyness" also did not influence tissue-type plasminogen activator treatment times.
Presentation during a nursing shift change, a time of transition of care, did not delay thrombolytic use in eligible patients with acute ischemic stroke. Presentation with acute ischemic stroke at night did result in delays of care for patients undergoing interventional therapies.
根据到急诊科就诊的时间，某些医疗条件的住院死亡率更高。本研究的主要目的是确定在护理班次变更期间到达急诊科的急性缺血性脑卒中患者与在非班次变更时间就诊的患者相比，其溶栓使用率和功能结局是否相似。
回顾性分析 2005 年至 2010 年期间到一家初级卒中中心急诊科就诊的急性缺血性脑卒中患者。评估通知卒中团队、进行头部 CT 扫描以及开始静脉或动脉内溶栓的时间。评估溶栓率、死亡率、出院去向、国立卫生研究院卒中量表的变化以及 3 个月和 12 个月时改良巴氏量表的变化。
在 3133 例急性缺血性脑卒中患者中，有 917 例符合纳入标准。在护理班次变更期间、周末以及 7 月至 9 月就诊不会影响流程时间、溶栓率和功能结局。夜间就诊会导致动脉内溶栓时间延长，但静脉溶栓时间不会延长，死亡率更高，3 个月时改良巴氏量表的功能状态改善程度更小。急诊科的“繁忙程度”也不会影响组织型纤溶酶原激活剂治疗时间。
在符合条件的急性缺血性脑卒中患者中，护理班次变更时就诊并不会延迟溶栓治疗的使用。夜间发生急性缺血性脑卒中就诊会导致接受介入治疗的患者的治疗时间延迟。
