Rosenman Marc B, Oh Elissa, Richards Christopher T, Mendelson Scott, Lee Julia, Holl Jane L, Naidech Andrew M, Prabhakaran Shyam
Department of Pediatrics (MRB, JLH), Northwestern University and Lurie Children's Hospital; Center for Healthcare Studies (EO, CTR, SM, JLH, AMN); Department of Emergency Medicine (CTR); Department of Neurology (SM, AMN), Department of Preventive Medicine (JL), Northwestern University, Chicago, IL, USA; and Department of Neurology (SP), University of Chicago, Chicago, IL.
Neurol Clin Pract. 2020 Apr;10(2):106-114. doi: 10.1212/CPJ.0000000000000673.
To assess the risk of subsequent stroke among older patients discharged from an emergency department (ED) without a diagnosis of TIA or stroke.
Using electronic health record data from a large urban, university hospital and a community-based hospital, we analyzed patients aged 60-89 years discharged to home from the ED without an diagnosis of TIA or stroke. Based on the presence/absence of a head CT and the presence/absence of a chief complaint suggestive of TIA or stroke ("symptoms") during the index ED visit, we created 4 mutually exclusive groups (group 1, reference: head CT no, symptoms no; group 2: head CT no, symptoms yes; group 3: head CT yes, symptoms no; and group 4: head CT yes, symptoms yes). We calculated rates of stroke in the 30, 90, and 365 days after the index visit and used multivariable logistic regression to estimate odds ratios (ORs) for subsequent stroke.
Among 35,622 patients (mean age 70 years, 59% women, and 16% African American), unadjusted rates of stroke in 365 days were as follows: group 4: 2.5%; group 3: 1.1%; group 2: 0.69%; and group 1: 0.54%. The adjusted OR for stroke was 3.30 (95% confidence interval [CI], 1.61-6.76) in group 4, 1.56 (95% CI, 1.16-2.09) in group 3, and 0.61 (95% CI, 0.22-1.67) in group 2.
Among patients discharged from the ED without a diagnosis of TIA or stroke, the occurrence of a head CT and/or specific neurologic symptoms established a clinically meaningful risk gradient for subsequent stroke.
评估在未诊断为短暂性脑缺血发作（TIA）或中风的情况下从急诊科（ED）出院的老年患者发生后续中风的风险。
利用一家大型城市大学医院和一家社区医院的电子健康记录数据，我们分析了年龄在60 - 89岁之间、从急诊科出院且未诊断为TIA或中风的患者。根据首次急诊科就诊时是否进行头部CT检查以及是否存在提示TIA或中风的主要症状（“症状”），我们创建了4个相互排斥的组（第1组，参照组：头部CT检查阴性，症状阴性；第2组：头部CT检查阴性，症状阳性；第3组：头部CT检查阳性，症状阴性；第4组：头部CT检查阳性，症状阳性）。我们计算了首次就诊后30天、90天和365天的中风发生率，并使用多变量逻辑回归来估计后续中风的比值比（OR）。
在35622例患者中（平均年龄70岁，59%为女性，16%为非裔美国人），365天内未调整的中风发生率如下：第4组：2.5%；第3组：1.1%；第2组：0.69%；第1组：0.54%。第4组中风的调整后OR为3.30（95%置信区间[CI]，1.61 - 6.76），第3组为1.56（95%CI，1.16 - 2.09），第2组为0.61（95%CI，0.22 - 1.67）。
在未诊断为TIA或中风的情况下从急诊科出院的患者中，头部CT检查的进行和/或特定的神经系统症状为后续中风建立了具有临床意义的风险梯度。
