Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Preventive Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):1001-18. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.016. Epub 2013 Oct 6.
The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions.
A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009.
Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001).
We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.
综合卒中护理能力与卒中干预的医院量之间的关联尚不确定。我们在日本进行了一项全国性调查，以研究综合卒中护理能力对卒中干预的医院量的影响。
向 1369 家专业培训机构发送了一份关于医院特征、组织型纤溶酶原激活剂（t-PA）方案以及 25 项关于人员、诊断、特定专业知识、基础设施和综合卒中中心（CSC）推荐的教育内容的问卷。我们检查了医院特征、t-PA 方案以及完成的 CSC 项目数量（总 CSC 评分）对 2009 年 t-PA 输注、脑出血清除以及颅内动脉瘤的线圈和夹闭的医院量的影响。
约有 55%的医院对调查做出了回应。有 t-PA 方案的设施（85%）更有可能拥有 23 个 CSC 项目，例如人员（例如神经外科医生：97.3%比 66.1%和神经科医生：51.3%比 27.7%）、诊断（例如数字脑血管造影：87.4%比 43.2%）、特定专业知识（例如夹闭和线圈：97.2%和 54%比 58.9%和 14.3%）、基础设施（例如重症监护病房：63.9%比 33.9%）和教育（例如专业教育：65.2%比 20.7%）。在调整了医院特征后，总 CSC 评分，但不是 t-PA 方案，与所有类型干预的量呈显著相关，且呈明显的递增趋势（趋势 P <.001）。
我们在日本证明了综合卒中护理能力与卒中干预的医院量之间存在显著关联。
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