Ekundayo Olaniyi James, Saver Jeffrey L, Fonarow Gregg C, Schwamm Lee H, Xian Ying, Zhao Xin, Hernandez Adrian F, Peterson Eric D, Cheng Eric M
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA.
Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):262-9. doi: 10.1161/CIRCOUTCOMES.113.000089. Epub 2013 Apr 29.
Prior studies found that only about half of stroke patients arrived at hospitals via emergency medical services (EMSs), yet since then, there have been efforts to increase public awareness that time is brain. Using contemporary Get With the Guidelines-Stroke data, we assessed nationwide EMS use by stroke patients.
We analyzed data from 204 591 patients with ischemic and hemorrhagic stroke admitted to 1563 Get With the Guidelines-Stroke participating hospitals with data on National Institute of Health Stroke Score and insurance status. Hospital arrival by EMSs was observed in 63.7% of patients. Older patients, those with Medicaid and Medicare insurance, and those with severe stroke were more likely to activate EMSs. In contrast, minority race and ethnicity and living in rural communities were associated with decreased odds of EMS use. EMS transport was independently associated with earlier arrival (onset-to-door time, ≤3 hours; adjusted odds ratio, 2.00; 95% confidence interval, 1.93-2.08), prompter evaluation (more patients with door-to-imaging time, ≤25 minutes; odds ratio, 1.89; 95% confidence interval, 1.78-2.00), more rapid treatment (more patients with door-to-needle time, ≤60 minutes; odds ratio, 1.44; 95% confidence interval, 1.28-1.63), and more eligible patients to be treated with tissue-type plasminogen activator if onset is ≤2 hours (67% versus 44%; odds ratio, 1.47; 95% confidence interval, 1.33-1.64).
Although EMS use is independently associated with more rapid evaluation and treatment of stroke, more than one third of stroke patients fail to use EMSs. Interventions aimed at increasing EMS activation should target populations at risk, particularly younger patients and those of minority race and ethnicity.
先前的研究发现，只有约一半的中风患者通过紧急医疗服务（EMS）送往医院，但自那时以来，一直在努力提高公众对“时间就是大脑”这一观念的认识。利用当代“遵循卒中指南”的数据，我们评估了全国范围内中风患者使用EMS的情况。
我们分析了1563家参与“遵循卒中指南”的医院收治的204591例缺血性和出血性中风患者的数据，这些数据包括美国国立卫生研究院卒中量表评分和保险状况。63.7%的患者通过EMS送往医院。老年患者、有医疗补助和医疗保险的患者以及中风严重的患者更有可能呼叫EMS。相比之下，少数族裔以及居住在农村社区与使用EMS的几率降低有关。EMS转运与更早到达（发病至入院时间≤3小时；调整后的优势比为2.00；95%置信区间为1.93 - 2.08）、更及时的评估（更多患者的入院至影像检查时间≤25分钟；优势比为1.89；95%置信区间为1.78 - 2.00）、更快速的治疗（更多患者的入院至穿刺时间≤60分钟；优势比为1.44；95%置信区间为1.28 - 1.63）以及如果发病≤2小时更多符合条件的患者接受组织型纤溶酶原激活剂治疗（67%对44%；优势比为1.47；95%置信区间为1.33 - 1.64）独立相关。
尽管使用EMS与更快速地评估和治疗中风独立相关，但超过三分之一的中风患者未使用EMS。旨在增加EMS启动的干预措施应针对高危人群，特别是年轻患者以及少数族裔患者。
