Scherf S, Limburg M, Wimmers R, Middelkoop I, Lingsma H
Department of Neurology, Canisius Wilhelmina ziekenhuis, Nijmegen, Netherlands.
Department of Neurology, Flevoziekenhuis, Almere, Netherlands.
BMC Neurol. 2016 Apr 21;16:53. doi: 10.1186/s12883-016-0574-7.
Intravenous thrombolytic therapy after ischaemic stroke significantly reduces mortality and morbidity. Actual thrombolysis rates are disappointingly low in many western countries. It has been suggested that higher patient volume is related to shorter door-to-needle-time (DNT) and increased thrombolysis rates. We address a twofold research question: a) What are trends in national thrombolysis rates and door-to-needle times in the Netherlands between 2005-2012? and b) Is there a relationship between stroke patient volume per hospital, thrombolysis rates and DNT?
We used data from the Stroke Knowledge Network Netherlands dataset. Information on volume, intravenous thrombolysis rates, and admission characteristics per hospital is acquired through yearly surveys, in up to 65 hospitals between January 2005 and December 2012. We used linear regression to determine a possible relationship between hospital stroke admission volume, hospital thrombolysis rates and mean hospital DNT, adjusted for patient characteristics.
Information on 121.887 stroke admissions was available, ranging from 7.393 admissions in 2005 to 24.067 admissions in 2012. Mean national thrombolysis rate increased from 6.4% in 2005 to 14.6% in 2012. Patient characteristics (mean age, gender, type of stroke) remained stable. Mean DNT decreased from 72.7 min in 2005 to 41.4 min in 2012. Volume of stroke admissions was not an independent predictor for mean thrombolysis rate nor for mean DNT.
Intravenous thrombolysis rates in the Netherlands more than doubled between 2005 and 2012, in parallel with a large decline in mean DNT. We found no convincing evidence for a relationship between stroke patient volume per hospital and thrombolysis rate or DNT.
缺血性卒中后静脉溶栓治疗可显著降低死亡率和发病率。在许多西方国家，实际溶栓率低得令人失望。有人提出，更高的患者数量与更短的门到针时间（DNT）及更高的溶栓率相关。我们提出了一个双重研究问题：a）2005年至2012年期间荷兰全国溶栓率和门到针时间的趋势如何？b）每家医院的卒中患者数量、溶栓率和DNT之间是否存在关系？
我们使用了荷兰卒中知识网络数据集的数据。通过年度调查获取了每家医院的病例数、静脉溶栓率和入院特征信息，调查对象为2005年1月至2012年12月期间多达65家医院。我们使用线性回归来确定医院卒中入院病例数、医院溶栓率和平均医院DNT之间的可能关系，并对患者特征进行了调整。
可获得121887例卒中入院病例的信息，从2005年的7393例入院病例到2012年的24067例入院病例。全国平均溶栓率从2005年的6.4%增至2012年的14.6%。患者特征（平均年龄、性别、卒中类型）保持稳定。平均DNT从2005年的72.7分钟降至2012年的41.4分钟。卒中入院病例数既不是平均溶栓率的独立预测因素，也不是平均DNT的独立预测因素。
2005年至2012年期间，荷兰的静脉溶栓率增加了一倍多，同时平均DNT大幅下降。我们没有找到令人信服的证据表明每家医院的卒中患者数量与溶栓率或DNT之间存在关系。
