Desseigne Nicolas, Akharzouz Delphine, Varvat Jérôme, Cheynet Marie, Pouzet Valérie, Marjollet Olivier, Garnier Pierre, Viallon Alain
CHU de Saint-Étienne, structure d'accueil des urgences adultes, 42055 Saint-Étienne, France.
Presse Med. 2012 Nov;41(11):e559-67. doi: 10.1016/j.lpm.2012.01.041. Epub 2012 May 3.
To analyse the factors influencing the time of admission of patients presenting an acute ischaemic stroke (AIS) to the emergency department.
Between May 2006 and July 2007, all patients with suspected stroke admitted to the emergency department were included. Patients' characteristics and the nature and timing of the events following symptom detection were recorded in the emergency department. The symptoms observed, the person telephoning for help, the person or establishment contacted, the measures implemented (attendance of a physician, medical or paramedical intervention) and the means of transport to the hospital were noted. The overall population was analysed descriptively and patients admitted within 3 hours of symptom onset (group I) were compared with those admitted after a longer interval (group II). The final diagnosis of AIS was confirmed on patient discharge. The results were expressed as the mean (± SD) or median (interquartile range), Mann-Whitney and Chi(2) tests being used to analyse differences between the two groups (threshold of statistical significance: P<0.05).
Among the 678 patients admitted with suspected stroke, 536 were diagnosed as having experienced an AIS, 65 a haemorrhagic stroke, 3 a cerebral venous thrombosis and 74 an event other than an acute neurovascular event. The results therefore concern 536 patients (median age: 75 years), of whom 166 (31%, group I) were admitted within 3 hours of symptom onset and 370 after a longer interval (group II). The median time between symptom onset and the call for help was 15 min (1-26) in group I and 300 min (60-960) in group II (P<0.0001). The median times to intervention of a physician (the patient's regular general practitioner, the physician on duty, or the SMUR [Mobile Emergency and Resuscitation Service] physician) ranged from 10 to 60 min. Median transport times ranged from 30 to 120 min depending on the type of transport employed. The two groups differed significantly with regard to intervention of a physician before admission to the emergency department (40% of patients in group I vs. 72% in group II, P<0.0001), initial call to the emergency medical call centre ("15" in France) (42% vs. 17%, P<0.001), presence of a relative or other person at the time of functional symptom onset (58% vs. 39%, P<0.01), and immediate transport to hospital without medical intervention (49 vs. 11%). Finally, irrespective of the time to hospital admission, 12% of the patients studied were eligible for intravenous thrombolysis.
In the event of a suspected stroke, these results favour contacting the emergency medical call centre and immediate transfer of the patient to an appropriate hospital establishment without waiting for prior medical intervention.
分析影响急性缺血性卒中（AIS）患者进入急诊科就诊时间的因素。
纳入2006年5月至2007年7月期间所有因疑似卒中进入急诊科的患者。在急诊科记录患者的特征以及症状出现后事件的性质和时间。记录观察到的症状、呼救者、联系的人员或机构、实施的措施（医生到场、医疗或辅助医疗干预）以及前往医院的交通方式。对总体人群进行描述性分析，并将症状发作后3小时内入院的患者（第一组）与更长间隔后入院的患者（第二组）进行比较。AIS的最终诊断在患者出院时确定。结果以均值（±标准差）或中位数（四分位间距）表示，采用Mann-Whitney检验和卡方检验分析两组之间的差异（统计学显著性阈值：P<0.05）。
在678例因疑似卒中入院的患者中，536例被诊断为发生了AIS，65例为出血性卒中，3例为脑静脉血栓形成，74例为非急性神经血管事件。因此结果涉及536例患者（中位年龄：75岁），其中166例（31%，第一组）在症状发作后3小时内入院，370例在更长间隔后入院（第二组）。第一组症状发作至呼救的中位时间为15分钟（1-26分钟），第二组为300分钟（60-960分钟）（P<0.0001）。医生（患者的常规全科医生、值班医生或移动紧急复苏服务[SMUR]医生）进行干预的中位时间为10至60分钟。根据所采用的交通方式，中位转运时间为30至120分钟。两组在进入急诊科前医生的干预情况（第一组40%的患者，第二组72%的患者，P<0.0001）、首次拨打紧急医疗呼叫中心（法国的“15”）的情况（42%对17%，P<0.001）、功能症状发作时亲属或其他人在场的情况（58%对39%，P<0.01）以及未经医疗干预直接转运至医院的情况（49对11）方面存在显著差异。最后，无论入院时间如何，12%的研究患者符合静脉溶栓条件。
对于疑似卒中患者，这些结果支持联系紧急医疗呼叫中心并将患者立即转运至合适的医院机构，而无需等待事先的医疗干预。
