From the Saddleback Memorial Medical Center, Laguna Hills, CA (R.I.R.).
Department of Neurology, University of California, Los Angeles (R.I.R.).
Stroke. 2018 May;49(5):1217-1222. doi: 10.1161/STROKEAHA.118.020620. Epub 2018 Apr 6.
In Orange County, California, patients with suspected acute stroke are taken to stroke neurology receiving centers that are designated by County Emergency Medical Services authorities as either hubs or spokes based on endovascular treatment capability. We examined relationships between stroke details, reperfusion therapies, hospital transfers, and their change over time.
All patients from January 1, 2013, to December 31, 2015, for whom 911 was called within 7 hours of onset in whom Emergency Medical Services personnel suspected acute stroke were evaluated.
Among 6132 patients, 3924 (64%) had confirmed diagnosis of stroke (74% ischemic/26% hemorrhagic), yielding diagnostic precision of 64% in the field. Of the 2892 patients with acute ischemic stroke, acute reperfusion therapy was given to 29.2% (21.7% intravenous tPA [tissue-type plasminogen activator] only and 7.5% endovascular treatment). Rates of endovascular treatment of patients with ischemic stroke increased over time, more than doubling from 5.6% in 2013 to 12.5% (odds ratio per 3-month quarter=1.09; 95% confidence interval, 1.04-1.14; <0.0001). Only 3.4% of patients with acute ischemic stroke were transferred from a spoke to a hub hospital; transfer rates were inversely related to age (<0.0001), and reperfusion therapy rates did not vary according to transfer status.
Favorable features of this acute stroke care system include reperfusion therapy in 29.2% of patients with ischemic stroke and substantial increases in endovascular treatment rates over time. Continued efforts to optimize acute stroke systems of care can be directed toward improving access to best acute stroke therapies.
在加利福尼亚州奥兰治县，疑似急性脑卒中的患者被送往县紧急医疗服务当局指定的脑卒中神经科接收中心，这些中心根据血管内治疗能力被指定为枢纽或辐条。我们研究了脑卒中细节、再灌注治疗、医院转院及其随时间变化的关系。
对 2013 年 1 月 1 日至 2015 年 12 月 31 日期间发病 7 小时内呼叫 911 的所有患者进行评估，这些患者的急救人员怀疑患有急性脑卒中。
在 6132 例患者中，3924 例（64%）确诊为脑卒中（74%为缺血性/26%为出血性），现场诊断准确率为 64%。在 2892 例急性缺血性脑卒中患者中，急性再灌注治疗率为 29.2%（21.7%仅给予静脉组织型纤溶酶原激活物（tPA）和 7.5%血管内治疗）。缺血性脑卒中患者的血管内治疗率随时间推移而增加，从 2013 年的 5.6%增加到 12.5%（每 3 个月季度比值比=1.09；95%置信区间，1.04-1.14；<0.0001）。仅有 3.4%的急性缺血性脑卒中患者从辐条医院转至枢纽医院；转院率与年龄呈负相关（<0.0001），且再灌注治疗率与转院状态无关。
该急性脑卒中治疗系统的有利特征包括 29.2%的缺血性脑卒中患者接受再灌注治疗，以及血管内治疗率随时间推移显著增加。持续努力优化急性脑卒中护理系统可以致力于改善获得最佳急性脑卒中治疗的机会。
