Saint Luke's Neuroscience Institute, 4401 Wornall Road, Suite 3112, Kansas City, MO 64111, USA.
Stroke. 2013 Jan;44(1):132-7. doi: 10.1161/STROKEAHA.112.666578. Epub 2012 Nov 13.
Compare access and outcomes in a tertiary care community hospital (Saint Luke's Neuroscience Institute) and its stroke network to hospitals in 3 national databases.
Retrospective analysis of ischemic stroke patients (2005, 2007, 2010) in Saint Luke's (n=1576), Get With The Guidelines-Stroke (n=423 809), Premier (n=91 598), and Merci Registry (n=966). Study measures were use of computed tomography scans and tissue plasminogen activator (tPA), symptomatic intracranial hemorrhage, discharge disposition, discharge National Institutes of Health Stroke Scale scores, and 90-day modified Rankin Scores.
Saint Luke's increased access to care with higher tPA use than other hospitals (17.2% received intravenous tPA therapy compared with 5.8% at Get With The Guidelines-Stroke hospitals, P<0.001; 22.1% of Saint Luke's patients received tPA by any route compared with 3.5% of Premier patients, P<0.001). Use of intravenous tPA within 4.5 hours of onset was associated with more discharges to home (odds ratio, 2.123; 95% confidence interval, 1.394-3.246) and improved National Institutes of Health Stroke Scale scores (P=0.001). Saint Luke's patients also were more likely than those in other hospitals to receive computed tomography scans (99.4% vs 58.6% at Premier hospitals). Embolectomy at Saint Luke's was associated with better outcomes than peer hospitals, and treatment at Saint Luke's was independently associated with more discharges to home (odds ratio, 3.92; 95% confidence interval, 1.84-8.32). In 2010, symptomatic intracranial hemorrhages after tPA therapy was similar for Saint Luke's patients and Premier patients (2.2% vs 1.5%; P=0.590).
Regionally coordinated stroke programs can substantially improve access and patient outcomes.
将三级社区医院（圣卢克神经科学研究所）及其卒中网络与三个国家数据库中的医院进行比较，以评估其在获取途径和结局方面的差异。
对圣卢克医院（2005 年、2007 年、2010 年）的缺血性卒中患者（n=1576）、Get With The Guidelines-Stroke 数据库（n=423809）、Premier 数据库（n=91598）和 Merci 登记库（n=966）中的患者进行回顾性分析。研究措施包括使用计算机断层扫描和组织型纤溶酶原激活物（tPA）、症状性颅内出血、出院去向、出院时国立卫生研究院卒中量表评分（NIHSS）和 90 天改良 Rankin 量表评分。
与其他医院相比，圣卢克医院的获取途径增加，tPA 使用率更高（接受静脉内 tPA 治疗的患者比例为 17.2%，而 Get With The Guidelines-Stroke 医院为 5.8%，P<0.001；任何途径使用 tPA 的患者比例为 22.1%，而 Premier 医院为 3.5%，P<0.001）。发病 4.5 小时内使用静脉内 tPA 与更多的出院回家（比值比，2.123；95%置信区间，1.394-3.246）和 NIHSS 评分改善（P=0.001）相关。与其他医院相比，圣卢克医院的患者更有可能接受计算机断层扫描（99.4% vs 58.6%，与 Premier 医院相比）。圣卢克医院的取栓治疗效果优于同类医院，且圣卢克医院的治疗与更多的出院回家独立相关（比值比，3.92；95%置信区间，1.84-8.32）。2010 年，圣卢克医院和 Premier 医院 tPA 治疗后症状性颅内出血的发生率相似（2.2% vs 1.5%；P=0.590）。
区域协调的卒中项目可显著改善获取途径和患者结局。
