Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
Neurology. 2012 Aug 28;79(9):941-4. doi: 10.1212/WNL.0b013e318266fc40.
Early mortality is a potential measure of the quality of care provided to hospitalized stroke patients. Whether in-hospital stroke mortality is reflective of deviations from evidence-based practices or patient/family preferences on life-sustaining measures is unclear.
All ischemic stroke mortalities at an academic medical center were reviewed to better understand the causes of inpatient stroke mortality.
Among 37 deaths or discharges to hospice in 2009, 36 occurred after a patient/family decision to withdraw/withhold potentially life-sustaining interventions. An independent survey of 3 vascular neurologists revealed that some early deaths could have been delayed beyond 30 days if patients or families had agreed to more aggressive measures. From these data, we estimate the magnitude of a "withdrawal of care" bias to be approximately 40% of the observed short-term mortality.
Acute stroke mortality may be more reflective of patient/family preferences than the provision of evidence-based care.
住院脑卒中患者的早期死亡率是衡量医疗服务质量的一个潜在指标。目前尚不清楚住院脑卒中死亡率是否反映了对循证实践的偏离，还是反映了患者/家属对维持生命措施的偏好。
本研究旨在通过分析某学术医疗中心的所有缺血性脑卒中死亡病例，以更好地了解住院脑卒中患者死亡的原因。
在 2009 年的 37 例死亡或临终关怀出院病例中，36 例是在患者/家属决定撤回/拒绝潜在的维持生命的干预措施后发生的。对 3 名血管神经科医生进行的独立调查显示，如果患者或家属同意采取更积极的治疗措施，一些早期死亡可能会延迟 30 天以上。根据这些数据，我们估计“放弃治疗”的偏差程度约为观察到的短期死亡率的 40%。
急性脑卒中死亡率可能更能反映患者/家属的偏好，而不是提供循证护理。
