Al-Khaled Mohamed, Matthis Christine, Seidel Günter
Department of Neurology, University of Lübeck, Lübeck, Germany.
Clin Neurol Neurosurg. 2013 Jun;115(6):725-8. doi: 10.1016/j.clineuro.2012.08.016. Epub 2012 Aug 22.
Transient ischemic attack (TIA) is associated with high short-term risk of stroke, especially in the early phase following the event. Data about the impact of the early hospitalization in a stroke unit on patients with TIA are sparse. This study compares the prognostic impact of the stroke unit concept with conventional care on patients with TIA.
During a 30-month period (beginning April 2005), 878 patients (mean age, 70±12years; 44.3% female) with TIA admitted within 24h of symptom onset were prospectively evaluated. The adjusted logistic regression analyses were used to estimate the odds ratio for the stroke risk during hospitalization and the 90-day mortality.
Of 878 patients, 591 (67.3%) were treated in the stroke unit, and 287 (32.7%) underwent conventional care. Patients receiving stroke-unit care had significantly higher rates of cranial computed tomography (96.3% vs. 88.1%; P<.001) and brain-supplying artery ultrasound (97.1% vs. 91.3%; P<.001) investigations. The stroke risk during hospitalization was 1.7% in patients treated in stroke unit and 2.4% in patients received a conventional care. A relevant difference between the groups was not found (1.7% vs. 2.4%; P=.45). The 90-day mortality rate was 1.7% in the stroke unit group compared to 2.2% in the conventional care group (1.7% vs. 2.2%; P=.66). The adjusted logistic regression analyses revealed no difference in stroke rates (odds ratio, 0.68; 95% confidence interval, 0.24-1.9) and in the 90-day mortality (odds ratio, 0.63; 95% confidence interval, 0.2-1.96) between the stroke unit concept and conventional care.
The prognostic impact of the stroke unit care for patients with transient ischemic attack appears to be similar to that of the conventional care. Further randomized studies are needed to investigate the impact of stroke-unit care on patients with transient ischemic attack.
短暂性脑缺血发作（TIA）与卒中的短期高风险相关，尤其是在事件发生后的早期阶段。关于卒中单元早期住院治疗对TIA患者影响的数据稀少。本研究比较了卒中单元概念与传统治疗对TIA患者的预后影响。
在30个月期间（从2005年4月开始），对症状发作后24小时内入院的878例TIA患者（平均年龄70±12岁；44.3%为女性）进行前瞻性评估。采用校正逻辑回归分析来估计住院期间卒中风险的比值比和90天死亡率。
878例患者中，591例（67.3%）在卒中单元接受治疗，287例（32.7%）接受传统治疗。接受卒中单元治疗的患者进行头颅计算机断层扫描（96.3%对88.1%；P<0.001）和脑供血动脉超声检查（97.1%对91.3%；P<0.001）的比例显著更高。在卒中单元接受治疗的患者住院期间卒中风险为1.7%，接受传统治疗的患者为2.4%。两组之间未发现显著差异（1.7%对2.4%；P=0.45）。卒中单元组的90天死亡率为1.7%，传统治疗组为2.2%（1.7%对2.2%；P=0.66）。校正逻辑回归分析显示，卒中单元概念与传统治疗在卒中发生率（比值比，0.68；95%置信区间，0.24 - 1.9）和90天死亡率（比值比，0.63；95%置信区间，0.2 - 1.96）方面无差异。
卒中单元护理对短暂性脑缺血发作患者的预后影响似乎与传统护理相似。需要进一步的随机研究来调查卒中单元护理对短暂性脑缺血发作患者的影响。
