Department of Neurology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Neurology. 2013 Apr 30;80(18):1702-9. doi: 10.1212/WNL.0b013e318293e2fe. Epub 2013 Apr 17.
We sought to determine the rate of urine toxicology screening, differences in testing, and outcomes among patients with stroke and TIA presenting to a tertiary care emergency department.
In this retrospective cohort study, patients admitted with stroke or TIA to a single tertiary care stroke center between June 2005 and January 2007 were identified through a stroke database. Factors that predicted urine toxicology screening of patients and a positive test, and discharge outcomes of patients based on toxicology result were analyzed. Stroke severity, treatment with tissue plasminogen activator, discharge status, and stroke etiology were compared between toxicology positive and negative patients.
A total of 1,024 patients were identified: 704 with ischemic stroke, 133 with intracerebral hemorrhage, and 205 with TIA. Urine toxicology screening was performed in 420 patients (40%); 11% of these studies were positive for cocaine (19% younger than 50 years and 9% 50 years or older). Factors that significantly predicted the performance of a urine toxicology screen were younger age (<50 years) and black race (<0.001). Positive toxicology screens occurred in a broad range of patients. There were no significant differences in admission NIH Stroke Scale score, stroke etiology, and discharge status between toxicology-positive and -negative patients.
In this study, patients with stroke and TIA who were young and black were more likely to have urine toxicology screening. Eleven percent of all tested patients (and 9% of patients 50 years or older) were positive for cocaine. To avoid disparities, we suggest that all stroke and TIA patients be tested.
我们旨在确定在就诊于三级护理急诊的中风和 TIA 患者中，尿液毒物筛查的比例、检测差异以及结果。
在这项回顾性队列研究中，通过中风数据库确定了 2005 年 6 月至 2007 年 1 月期间在一家三级护理中风中心就诊的中风或 TIA 患者。分析了预测患者尿液毒物筛查以及毒物筛查阳性患者的出院结果的因素，以及根据毒物筛查结果的患者出院情况。比较了毒物筛查阳性和阴性患者的中风严重程度、组织型纤溶酶原激活剂治疗、出院状态和中风病因。
共确定了 1024 名患者：704 名缺血性中风患者、133 名脑出血患者和 205 名 TIA 患者。对 420 名患者进行了尿液毒物筛查（40%）；其中 11%的研究可卡因检测呈阳性（9%的患者年龄小于 50 岁，9%的患者年龄在 50 岁或以上）。显著预测尿液毒物筛查的因素是年龄较小（<50 岁）和黑人种族（<0.001）。毒物筛查阳性的患者分布广泛。毒物筛查阳性和阴性患者的入院 NIH 中风量表评分、中风病因和出院状态无显著差异。
在这项研究中，年轻和黑人的中风和 TIA 患者更有可能接受尿液毒物筛查。在所有接受检测的患者中，有 11%（9%的患者年龄在 50 岁或以上）可卡因检测呈阳性。为避免差异，我们建议对所有中风和 TIA 患者进行检测。
