Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Neurology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):213-9. doi: 10.1016/j.jstrokecerebrovasdis.2012.12.001. Epub 2013 Jan 8.
Data concerning quality of acute stroke care and outcome are scarce in developing countries.
This study aimed to evaluate quality of acute stroke care and stroke outcomes in Thailand.
We performed a multicenter countrywide prospective cohort study. Consecutive patients with an acute ischemic stroke admitted to the participating institutions between June 2008 and November 2010 were included. Baseline characteristics, process measures including thrombolysis use, acute stroke unit admission, initiation of aspirin within 48 hours, and antithrombotic and/or anticoagulation medication at discharge were recorded. Main outcome measures were death and disability at discharge as well as in-hospital complications.
A total of 1222 patients were included with a mean (±SD) age of 65.0 ± 13 years, and 55.0% were men. Median National Institutes of Health Stroke Scale score was 6.5. Patients were given aspirin within 48 hours, admitted to acute stroke unit, and given thrombolytic therapy in 71.1%, 24.6%, and 3.8%, respectively. Good recovery at discharge (modified Rankin scale score 0-1) was found in 26.1%, and 3.2% of patients died during hospitalization. The median length of stay was 4 days. Factors predicting poor outcome (modified Rankin scale score 5-6) at discharge included: age (by 10-year increments: adjusted odds ratio [OR] 1.23; 95% confidence interval [CI], 1.06-1.43), female sex (adjusted OR 1.52; 95% CI, 1.05-2.19), initial National Institutes of Health Stroke Scale score (adjusted OR 1.35; 95% CI, 1.27-1.43), and in-hospital complications (adjusted OR 3.16; 95% CI, 1.58-6.35).
Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.
发展中国家有关急性脑卒中护理质量和结局的数据十分匮乏。
本研究旨在评估泰国急性脑卒中护理质量和脑卒中结局。
我们开展了一项多中心全国前瞻性队列研究。将 2008 年 6 月至 2010 年 11 月期间收入参与机构的连续急性缺血性脑卒中患者纳入研究。记录基线特征、包括溶栓治疗使用、急性脑卒中单元收治、48 小时内开始使用阿司匹林、出院时使用抗血小板和（或）抗凝药物等治疗过程指标。主要结局指标为出院时以及住院期间的死亡和残疾情况以及院内并发症。
共纳入 1222 例患者，平均（±SD）年龄为 65.0±13 岁，55.0%为男性。美国国立卫生研究院脑卒中量表评分中位数为 6.5。患者在 48 小时内使用阿司匹林、收治于急性脑卒中单元以及接受溶栓治疗的比例分别为 71.1%、24.6%和 3.8%。出院时恢复良好（改良 Rankin 量表评分 0-1）的比例为 26.1%，3.2%的患者在住院期间死亡。中位住院时间为 4 天。出院时预后不良（改良 Rankin 量表评分 5-6）的预测因素包括：年龄（每增加 10 岁：校正比值比[OR] 1.23；95%置信区间[CI]，1.06-1.43）、女性（校正 OR 1.52；95%CI，1.05-2.19）、初始美国国立卫生研究院脑卒中量表评分（校正 OR 1.35；95%CI，1.27-1.43）和院内并发症（校正 OR 3.16；95%CI，1.58-6.35）。
许多领域，尤其是溶栓治疗和脑卒中单元收治方面，急性缺血性脑卒中治疗干预的可及性有限。这些发现强调了在发展中国家急需制定策略来改善急性脑卒中标准治疗。
