George Alexander J, Boehme Amelia K, Siegler James E, Monlezun Dominique, Fowler Bethena D, Shaban Amir, Albright Karen C, Beasley T Mark, Martin-Schild Sheryl
Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA ; Department of Neurology, School of Medicine, University of Alabama at Birmingham, 1670 University Blvd., Birmingham, AL 35233-0022, USA.
ISRN Stroke. 2013 Aug 14;2013. doi: 10.1155/2013/312348.
Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis.
Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours.
Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, = 0.0010). A larger proportion of patients with pLOS developed an infection ( < 0.0001), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17-4.32, = 0.0148). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83-3.35, = 0.1443).
The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay.
缺血性中风后住院时间延长（pLOS）会增加成本，增加医院获得性并发症的风险，并与较差的预后相关。
对2008年7月至2010年12月期间收治的急性缺血性中风患者进行回顾性分析，以确定pLOS，pLOS定义为已具备出院条件但仍需额外住院≥24小时的患者。
纳入的274例患者中，106例（38.7%）存在pLOS（中位年龄65岁，女性占60.6%，黑人占69.0%）。存在pLOS的患者入院时美国国立卫生研究院卒中量表（NIHSS）评分高于无pLOS的患者（分别为9分和5分，P = 0.0010）。存在pLOS的患者发生感染的比例更高（P < 0.0001），在对协变量进行调整后，这些患者短期功能预后不良的几率更高（比值比[OR]=2.25，95%置信区间[CI]为1.17 - 4.32，P = 0.0148）。在对感染进行调整后，存在pLOS的患者短期功能预后不良的几率不再具有统计学意义（OR = 1.68，95% CI为0.83 - 3.35，P = 0.1443）。
医院获得性感染是pLOS的重要预测因素，也是缺血性中风后短期预后不良的一个因素。无论医院获得性感染是pLOS的原因还是结果，它在很大程度上是可预防的，也是缩短住院时间的一个目标。
