Vargas Mariana, Costa Mariana, Pinho E Melo Teresa, Ferro José M, Fonseca Ana Catarina
Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Cerebrovasc Dis. 2017;44(1-2):68-74. doi: 10.1159/000475823. Epub 2017 May 4.
In 2010, changes were made to the shift pattern of neurology residents for cover in the Emergency Department at a university hospital. This resulted in a decrease in the number of emergency hours worked by neurology specialists and allowed for a natural quasi-experiment.
We aimed to evaluate if changes to the number of emergency hours worked by neurology residents and specialist neurologists, (intervention) altered the number or pattern of admitted stroke mimics (SMs).
Observational retrospective study from January 2007 to December 2013. Time of intervention was set as August 2010. We used a segmented linear regression - ARIMA - to evaluate changes in the temporal pattern of admitted SMs. A statistical correlation between the number of emergency hours worked by neurology residents and the number of admitted SMs was calculated using the Pearson Correlation Coefficient.
Of the 2,552 patients admitted to the stroke unit, 290 were SMs (11.4%). After August 2010, there was an increase in the number of admitted SMs (p = 0.003). After 2010, the most frequent SM diagnosis changed from a psychiatric condition to peripheral vertigo. A positive correlation was found between the number of hours worked primarily by neurology residents and the number of admitted SMs (Pearson correlation coefficient = 0.94; p = 0.002).
Changes in the pattern of Emergency Department shifts were associated with an increase in the rate of admitted SMs and with a higher number of mimics with a final diagnosis of peripheral vertigo.
2010年，一所大学医院对神经内科住院医师在急诊科的值班模式进行了调整。这导致神经内科专科医生的急诊工作时长减少，从而形成了一项自然的准实验。
我们旨在评估神经内科住院医师和专科医生的急诊工作时长变化（干预措施）是否改变了入院的类卒中（SMs）数量或模式。
对2007年1月至2013年12月进行观察性回顾研究。干预时间设定为2010年8月。我们使用分段线性回归-自回归积分移动平均模型（ARIMA）来评估入院SMs时间模式的变化。使用Pearson相关系数计算神经内科住院医师的急诊工作时长与入院SMs数量之间的统计相关性。
在入住卒中单元的2552例患者中，290例为SMs（11.4%）。2010年8月之后，入院SMs数量增加（p = 0.003）。2010年之后，最常见的SM诊断从精神疾病转变为周围性眩晕。主要由神经内科住院医师工作的时长与入院SMs数量之间存在正相关（Pearson相关系数 = 0.94；p = 0.002）。
急诊科值班模式的变化与入院SMs发生率的增加以及最终诊断为周围性眩晕的类卒中数量增加有关。
