From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
Stroke. 2015 Apr;46(4):1065-70. doi: 10.1161/STROKEAHA.114.007608. Epub 2015 Feb 12.
Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes.
Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on day 0, and swallow screen recorded on day 0) on mortality and discharge to usual residence, at 30 days and 6 months. Data were corrected for the validated 6 simple variables, admission year, and hospital-level random effects.
A total of 36,055 patients were included. Achieving stroke unit admission, swallow screen, and aspirin standards were associated with reduced 30-day mortality (adjusted odds ratio [95% confidence interval]: 0.82 [0.75-0.90], 0.88 [0.77-0.99], and 0.39 [0.35-0.43], respectively). Thirty-day all-cause mortality was higher when fewer standards were achieved, from 0 versus 4 (adjusted odds ratio [95% confidence interval], 2.95 [1.91-4.55]) to 3 versus 4 (adjusted odds ratio [95% confidence interval], 1.21 [1.09-1.34]). This effect persisted at 6 months. When less than the full care bundle was achieved, discharge to usual residence was less likely at 6 months (3 versus 4 standards; adjusted odds ratio [95% confidence interval], 0.91 [0.85-0.98]).
Achieving a care bundle for ischemic stroke is associated with reduced mortality at 30 days and 6 months and increased likelihood of discharge to usual residence at 6 months.
需要进一步研究以更好地确定评估中风护理过程和结果的方法。我们调查了在苏格兰缺血性中风人群中实现护理包的 4 个循证组成部分是否与 30 天和 6 个月的结果相关。
使用国家数据集，我们研究了 4 个标准（入院当天或次日（第 1 天）进入卒中单元、第 0 天或第 1 天使用阿司匹林、第 0 天进行扫描以及第 0 天记录吞咽筛查）对 30 天和 6 个月时死亡率和出院到常住地的影响。数据经过校正后，纳入了验证过的 6 个简单变量、入院年份和医院级别的随机效应。
共纳入 36055 例患者。达到卒中单元入院、吞咽筛查和阿司匹林标准与降低 30 天死亡率相关（校正比值比[95%置信区间]：0.82[0.75-0.90]、0.88[0.77-0.99]和 0.39[0.35-0.43]）。实现的标准越少，30 天全因死亡率越高，从 0 与 4 相比（校正比值比[95%置信区间]，2.95[1.91-4.55]）到 3 与 4 相比（校正比值比[95%置信区间]，1.21[1.09-1.34]）。这种影响持续到 6 个月。当未完全实现完整护理包时，6 个月时出院到常住地的可能性较低（3 与 4 个标准相比；校正比值比[95%置信区间]，0.91[0.85-0.98]）。
实现缺血性中风护理包与 30 天和 6 个月时的死亡率降低以及 6 个月时出院到常住地的可能性增加相关。
