Del Brutto Victor J, Ardelt Agnieszka, Loggini Andrea, Bulwa Zachary, El-Ammar Faten, Martinez Raisa C, Brorson James, Goldenberg Fernando
Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Neurology, Metro Health Center, Cleveland, Ohio.
J Stroke Cerebrovasc Dis. 2019 May;28(5):1362-1370. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.001. Epub 2019 Mar 4.
Emergent evaluation of inpatients with suspected acute ischemic stroke faces difficulty of symptoms recognition, false alarms, and high rate of contraindications to reperfusion therapies. We aim to assess the clinical characteristics and therapeutic interventions implemented in patients evaluated though the in-hospital Stroke Alert Protocol.
We analyzed 4 years-worth of Stroke Alert cases at a university hospital. Demographics, clinical presentation, final diagnosis, and acute interventions were compared between inpatients and those presenting to the emergency department.
A total of 1965 Stroke Alert cases were included: 959 (48.8%) were acute cerebrovascular events and 1006 (51.2%) were noncerebrovascular. Hospitalized patients accounted for 489 (24.9%) of Stroke Alerts and patients in the emergency department for 1476 (75.1%). Inpatients were more likely to present with nonfocal neurological deficits (46.2% versus 32.4%, P < .0001) and be diagnosed with noncerebrovascular disorders (62.4% versus 47.5%, P < .0001). Acute interventions other than thrombolysis were delivered in 77.1% of in-hospital cases. Compared to the emergency department, inpatients were more commonly managed with rectification of metabolic abnormalities (21.5% versus 13.7%, P < .001), suspension or pharmacological reversal of drugs (11% versus 3.7%, P < .001), and initiation of respiratory support (13.5% versus 9.3%, P = .01). Inpatients with acute ischemic stroke received intravenous thrombolysis less frequently (4.9% versus 23.9%, P < .001), but the endovascular treatment rate was comparable (9.8% versus 10.3%) to the emergency department.
Nonfocal neurological deficits and noncerebrovascular disorders are commonly encountered during in-hospital Stroke Alerts. In the inpatient setting, intravenous thrombolysis is rarely delivered while other time-sensitive therapeutic interventions are frequently implemented.
对疑似急性缺血性卒中的住院患者进行紧急评估面临症状识别困难、误报以及再灌注治疗禁忌症发生率高的问题。我们旨在评估通过院内卒中预警方案评估的患者的临床特征和实施的治疗干预措施。
我们分析了一家大学医院4年的卒中预警病例。比较了住院患者与急诊科患者的人口统计学、临床表现、最终诊断和急性干预措施。
共纳入1965例卒中预警病例：959例（48.8%）为急性脑血管事件，1006例（51.2%）为非脑血管事件。住院患者占卒中预警病例的489例（24.9%），急诊科患者占1476例（75.1%）。住院患者更易出现非局灶性神经功能缺损（46.2%对32.4%，P<.0001），且更易被诊断为非脑血管疾病（62.4%对47.5%，P<.0001）。77.1%的住院病例实施了除溶栓之外的急性干预措施。与急诊科相比，住院患者更常接受代谢异常纠正（21.5%对13.7%，P<.001）、药物停用或药物药理学逆转（11%对3.7%，P<.001）以及启动呼吸支持（13.5%对9.3%，P=.01）。急性缺血性卒中住院患者接受静脉溶栓的频率较低（4.9%对23.9%，P<.001），但血管内治疗率与急诊科相当（9.8%对10.3%）。
在院内卒中预警期间，常遇到非局灶性神经功能缺损和非脑血管疾病。在住院患者中，很少进行静脉溶栓，而其他对时间敏感的治疗干预措施则经常实施。
