Sheedy Renee, Bernhardt Julie, Levi Christopher R, Longworth Mark, Churilov Leonid, Kilkenny Monique F, Cadilhac Dominique A
Barwon Health, Geelong, VIC, Australia; La Trobe University, Melbourne, VIC, Australia.
Int J Stroke. 2014 Jun;9(4):437-42. doi: 10.1111/ijs.12223. Epub 2013 Nov 21.
Providing evidence-based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence-based processes of care were different for patients with intracerebral haemorrhage when compared with ischemic stroke and sought to describe differences in health outcomes during hospitalization and at time of discharge for these stroke subtypes.
The New South Wales acute stroke dataset was used. This included data from 50-100 consecutively admitted patients' medical records collected from 32 New South Wales hospitals between 2003 and 2010. Multivariable logistic regression analyses were conducted taking into account patient factors and clustering of patients by hospital.
Ischemic stroke and intracerebral haemorrhage cases had similar demographic features (ischemic stroke n = 3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n = 275, mean age 74 years [standard deviation 13], 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0.65; 95% confidence interval 0.45-0.94) or receive an assessment from allied health (adjusted odds ratio 0.54; 95% confidence interval 0.33-0.89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0.36; 95% confidence interval 0.3-0.5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2.1; 95% confidence interval 1.3-3.5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0-2) at day 7-10 irrespective of stroke type or severity on admission (adjusted odds ratio 1.3; 95% confidence interval 1.01-1.66).
Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7-10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage.
提供循证临床护理可降低卒中后的残疾率和死亡率。我们比较了脑出血患者与缺血性卒中患者在遵循循证护理流程方面是否存在差异，并试图描述这些卒中亚型在住院期间和出院时健康结局的差异。
使用新南威尔士州急性卒中数据集。该数据集包括2003年至2010年间从新南威尔士州32家医院连续收集的50 - 100例患者的病历数据。进行多变量逻辑回归分析时考虑了患者因素以及患者在医院的聚类情况。
缺血性卒中和脑出血病例具有相似的人口统计学特征（缺血性卒中n = 3467，平均年龄74岁[标准差13]，50%为女性；脑出血n = 275，平均年龄74岁[标准差13]，48%为女性）。多变量分析后发现，与缺血性卒中患者相比，脑出血患者入住卒中单元的可能性较小（调整比值比0.65；95%置信区间0.45 - 0.94），接受联合健康评估的可能性也较小（调整比值比0.54；95%置信区间0.33 - 0.89）。脑出血患者在出院时独立的可能性也较小（调整比值比0.36；95%置信区间0.3 - 0.5），且在医院死亡的几率更高（调整比值比2.1；95%置信区间1.3 - 3.5）。无论入院时卒中类型或严重程度如何，入住卒中单元的患者在第7 - 10天独立（改良Rankin评分0 - 2）的几率更高（调整比值比1.3；95%置信区间1.01 - 1.66）。
脑出血后，患者入住急性卒中单元并接受联合健康干预措施可能性较小。入住卒中单元可提高第7 - 10天独立的可能性，因此，应采取更多措施鼓励对脑出血患者进行循证护理。
