Topiwala Karan, Tarasaria Karan, Staff Ilene, Beland Dawn, Schuyler Erica, Nouh Amre
Department of Neurology, University of Connecticut, Farmington, CT, United States.
Department of Research, Hartford Hospital, Hartford, CT, United States.
Front Neurol. 2020 Feb 26;11:134. doi: 10.3389/fneur.2020.00134. eCollection 2020.
Inpatient stroke-codes (ISC) have traditionally seen low treatment rates with IV-thrombolytic (IVT). The purpose of this study was to identify the predictors of true stroke, prevalent IVT-treatment gap and study the factors associated with such missed treatment opportunities (MTO). A retrospective chart review identified ISC from March 2017 to March 2018. Clinical, radiographic and demographic data were collected. Primary analysis was performed between stroke vs. non-stroke diagnoses. Dichotomous variables were analyzed using Chi-Square test of proportions and continuous variables with Wilcoxon-Ranked-Sum test. Significant factors were then tested in a multivariate logistic regression model for independence. From 211 ISC, 36% ( = 76) had an acute stroke. Hemorrhagic stroke (HS) was present in 5.7% ( = 12). Of the remaining 199, 44% ( = 87) were IVT-eligible but only 3.4% ( = 3) were treated. Of the remaining 84 IVT-eligible-but-untreated patients, 69(82.1%) were mimics, while 15 (17.9%) had an ischemic stroke (IS), constituting a MTO of 1 in 6 IVT-eligible patients, with National Institutes of Health Stroke Scale (NIHSS) ≤4 being the commonest deterrent. Independent predictors of stroke were ejection fraction (EF) <30% ( = 0.030, OR = 3.06), post-operative status ( = 0.001, OR = 3.71), visual field-cut ( = 0.008, OR = 3.70), and facial droop ( = 0.010, OR = 2.59). In our study, one in three ISC were true strokes. IVT treatment rates were low with a MTO of 1 in 6 IVT-eligible patients. The most common reason for not treating was NIHSS ≤4. Knowing predictors of true stroke and the common barriers to IVT treatment can help narrow this treatment gap.
住院卒中编码（ISC）患者接受静脉溶栓（IVT）治疗的比例传统上一直较低。本研究的目的是确定真正卒中的预测因素、普遍存在的IVT治疗差距，并研究与这种治疗机会错失（MTO）相关的因素。一项回顾性病历审查确定了2017年3月至2018年3月期间的ISC患者。收集了临床、影像学和人口统计学数据。对卒中与非卒中诊断进行了初步分析。二分变量采用比例卡方检验进行分析，连续变量采用Wilcoxon秩和检验进行分析。然后在多因素逻辑回归模型中对显著因素进行独立性检验。在211例ISC患者中，36%（n = 76）患有急性卒中。出血性卒中（HS）占5.7%（n = 12）。在其余199例患者中，44%（n = 87）符合IVT治疗条件，但只有3.4%（n = 3）接受了治疗。在其余84例符合IVT治疗条件但未接受治疗的患者中，69例（82.1%）为疑似病例，15例（17.9%）患有缺血性卒中（IS），这意味着每6例符合IVT治疗条件的患者中就有1例存在治疗机会错失，美国国立卫生研究院卒中量表（NIHSS）≤4是最常见的阻碍因素。卒中的独立预测因素包括射血分数（EF）<30%（p = 0.030，OR = 3.06）、术后状态（p = 0.001，OR = 3.71）、视野缺损（p = 0.008，OR = 3.70）和面部下垂（p = 0.010，OR = 2.59）。在我们的研究中, 三分之一的ISC患者为真正的卒中。IVT治疗率较低，每6例符合IVT治疗条件的患者中就有1例存在治疗机会错失。不进行治疗的最常见原因是NIHSS≤4。了解真正卒中的预测因素以及IVT治疗的常见障碍有助于缩小这种治疗差距。
