School of Nursing, University of Tasmania.
School of Nursing, University of Tasmania.
Australas Emerg Care. 2020 Dec;23(4):225-232. doi: 10.1016/j.auec.2020.05.004. Epub 2020 Sep 1.
Little is known about how transfers influence time to treatment for cases of aneurysmal subarachnoid hemorrhage (aSAH). We examine the effect of geographical location, socioeconomic status and inter-hospital transfer on time to treatment following an aSAH.
A state-wide retrospective cohort study was established from 2010-2014. Time intervals from ictus to treatment were calculated. Linear regression examined associations between transfer status, place of residence and socioeconomic status and log-transformed times to treatment.
The median (IQR) time to intervention was 13.78 (6.48-20.63) hours. Socioeconomic disadvantage was associated with a 1.52-fold increase in the time to hospital (p<0.05) and a 1.76-fold increase in time to neurosurgical admission (p<0.05). Residing in an outer regional area was associated with a 2.27-fold increase (p<0.05) in time to neurosurgical admission. Inter-hospital transfers were associated with a 6.26-fold increase in time to neurosurgical admission (p<0.05).
The time to treatment was negatively influenced by socioeconomic disadvantage; geographical location and inter-hospital transfers. The urgent transfer of individuals with suspected aSAH is undeniably necessary when neurosurgical services are unavailable locally. The timeliness and organisation of transfers should be reviewed to overcome the potential vulnerability to poor outcomes for people from rural and disadvantaged areas.
对于动脉瘤性蛛网膜下腔出血（aSAH）患者的治疗时间，转移的影响鲜为人知。我们研究了地理位置、社会经济地位和医院间转移对 aSAH 后治疗时间的影响。
从 2010 年至 2014 年进行了一项全州范围的回顾性队列研究。计算了从发病到治疗的时间间隔。线性回归分析了转移状态、居住地和社会经济地位与治疗时间对数之间的关系。
干预的中位数（IQR）时间为 13.78（6.48-20.63）小时。社会经济劣势与住院时间增加 1.52 倍（p<0.05）和神经外科入院时间增加 1.76 倍（p<0.05）相关。居住在远郊地区与神经外科入院时间增加 2.27 倍（p<0.05）相关。医院间转移与神经外科入院时间增加 6.26 倍（p<0.05）相关。
治疗时间受到社会经济劣势、地理位置和医院间转移的负面影响。当当地没有神经外科服务时，毫无疑问需要紧急转移疑似 aSAH 的患者。应审查转移的及时性和组织，以克服农村和劣势地区人民预后不良的潜在脆弱性。
