Kinsella Danny, Mosley Ian, Braitberg George
Alfred Health, Nursing Education, Australia; Sunshine Hospital, Neurology Department, Australia.
La Trobe University, School of Nursing & Midwifery, College of Science, Health & Engineering, Australia.
Australas Emerg Care. 2018 Aug;21(3):99-104. doi: 10.1016/j.auec.2018.07.001. Epub 2018 Aug 17.
Presentation by ambulance to the emergency department is critical for stroke patients to receive time dependent treatments. However, little is known of the factors that influence presentation by ambulance.
Retrospective analysis of all patients with an emergency department medical diagnosis of stroke who presented to one of three Victorian emergency departments over a three-year period (2011-2013). A multivariable model was used to investigate demographic characteristics (including triage assessment category, triage identified as stroke, time to CT, and time to diagnosis within the emergency department) as predictors of arrival by ambulance.
3548 stroke patients were identified; mean age was 70 years, 53% were males, and 92% had an ischemic stroke. Arrival by ambulance occurred in 71% (n=2509) with arrival by private transport accounting for 29% (n=1039) of patients. Factors significantly associated with arrival by ambulance were older age (p=<0.001), being born in Australia (p=<0.001), and speaking English in the home (p=0.003). Arrival by ambulance was independently associated with rapid stroke care in the emergency department, arrival within 2h from symptom onset, attending an advanced stroke service (access to thrombolysis), triaged for stroke, medical assessment within 25min and referral for CT within 45min.
In this Australian multicenter study, it was identified that patients who arrived by ambulance received faster acute stroke care within the emergency department. Public health education which targets patients who are younger and from a non-English speaking background is needed as these demographics were not associated with timely arrival by ambulance to the emergency department.
对于中风患者而言，通过救护车送往急诊科对于接受时效性治疗至关重要。然而，关于影响通过救护车送医的因素却知之甚少。
对在三年期间（2011 - 2013年）前往维多利亚州三个急诊科之一就诊且被急诊科诊断为中风的所有患者进行回顾性分析。使用多变量模型研究人口统计学特征（包括分诊评估类别、分诊确定为中风、CT检查时间以及在急诊科内的诊断时间）作为通过救护车送医的预测因素。
共识别出3548例中风患者；平均年龄为70岁，53%为男性，92%患有缺血性中风。71%（n = 2509）的患者通过救护车送医，29%（n = 1039）的患者通过私人交通工具送医。与通过救护车送医显著相关的因素包括年龄较大（p < 0.001）、出生在澳大利亚（p < 0.001）以及在家说英语（p = 0.003）。通过救护车送医与在急诊科快速进行中风治疗、症状发作后2小时内到达、前往高级中风服务机构（可进行溶栓治疗）、分诊为中风、25分钟内进行医学评估以及45分钟内转诊进行CT检查独立相关。
在这项澳大利亚多中心研究中，发现通过救护车送医的患者在急诊科接受了更快的急性中风治疗。需要针对年轻且来自非英语背景的患者开展公共卫生教育，因为这些人群与未能及时通过救护车到达急诊科相关。
