社会史很重要——非法药物使用对急性缺血性卒中患者使用组织型纤溶酶原激活剂及院内死亡率的影响
Social History Matters-The Impact of Illicit Drug Use on tPA Use and In-Hospital Mortality in Acute Ischemic Stroke.
作者信息
Marx Matthew H M, Albright Karen C, Shaban Amir, Boehme Amelia K, Beasley T Mark, Martin-Schild Sheryl
机构信息
Department of Neurology, Tulane University Hospital, New Orleans, LA 70112, United States.
Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), USA. ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC), USA. ; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, England. ; Department of Neurology, School of Medicine, University of Alabama at Birmingham, United States.
出版信息
Int Neuropsychiatr Dis J. 2014 May;2(3):127-135. doi: 10.9734/INDJ/2014/7708#sthash.g7FyGPTT.dpuf.
AIMS
The objective of this descriptive study was to compare time to medical evaluation, intravenous tissue plasminogen activator (IV tPA) use, and short-term outcomes in illicit drug users compared to non-users presenting with acute ischemic stroke (AIS).
STUDY DESIGN
This is a retrospective study performed from our stroke registry using deidentified patient information.
PLACE AND DURATION OF STUDY
Tulane Medical Center Primary Stroke Center (PSC). Consecutive AIS patients presenting to our PSC from July 2008 to December of 2010 were identified from our prospectively collected stroke registry.
METHODOLOGY
Patients were categorized as toxicology positive (TP) or toxicology negative (TN). We compared baseline characteristics, clinical presentation, tPA use, and short-term outcomes in TP and TN patients.
RESULTS
Two hundred and sixty-three patients met inclusion criteria (median age 63, 35.4% female, 66.5% Black). Nearly 40% of toxicology screens were positive. Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; however, a higher proportion of TN patients were treated with IV tPA (32.1% vs. 21.2%). After adjustment for time from last seen normal to emergency department arrival (LSN-to-ED arrival), the odds of being treated with tPA for TP patients were similar to TN patients (OR 0.69, 95% CI 0.36-1.31, p=0.255). After adjustment for age, NIHSS, glucose, and tPA, the odds of in-hospital mortality in TP patients was 3 times that of TN patients (OR 3.17, 95% CI 1.07-9.43, p=0.038).
CONCLUSION
We found that the disparities observed in tPA use were attenuated after adjustment for time from LSN-to-ED arrival, suggesting an area for future intervention. Additionally, we found that TP patients may be at higher risk for in-hospital mortality. Further study on the role of substance abuse in time to ED arrival, tPA use, and outcome in AIS patients is warranted.
目的
本描述性研究的目的是比较与急性缺血性卒中（AIS）患者相比，非法药物使用者就医评估时间、静脉注射组织型纤溶酶原激活剂（IV tPA）的使用情况以及短期预后。
研究设计
这是一项利用去识别化患者信息，从我们的卒中登记处开展的回顾性研究。
研究地点及持续时间
杜兰大学医学中心初级卒中中心（PSC）。从2008年7月至2010年12月到我们PSC就诊的连续AIS患者，是从我们前瞻性收集的卒中登记处识别出来的。
方法
患者被分类为毒理学阳性（TP）或毒理学阴性（TN）。我们比较了TP和TN患者的基线特征、临床表现、tPA使用情况以及短期预后。
结果
263名患者符合纳入标准（中位年龄63岁，女性占35.4%，黑人占66.5%）。近40%的毒理学筛查呈阳性。两组卒中严重程度相似，国立卫生研究院卒中量表（NIHSS）中位数均为6；然而，更高比例的TN患者接受了IV tPA治疗（32.1%对21.2%）。在调整从最后一次正常状态到急诊科就诊的时间（LSN到急诊科就诊时间）后，TP患者接受tPA治疗的几率与TN患者相似（比值比0.69，95%置信区间0.36至1.31，p = 0.255）。在调整年龄（NIHSS）、血糖和tPA后，TP患者院内死亡几率是TN患者的3倍（比值比3.17，95%置信区间1.07至9.43，p = 0.038）。
结论
我们发现，在调整LSN到急诊科就诊时间后，观察到的tPA使用差异有所减弱，这提示了一个未来干预的领域。此外，我们发现TP患者院内死亡风险可能更高。有必要进一步研究药物滥用在AIS患者到急诊科就诊时间、tPA使用及预后方面的作用。
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