Scherzer Stephan, Robledo Andrea, Stahl Karin, Nasri Sami, Kraft Peter
Department of Neurology, Hospital Main-Spessart, Grafen-von-Rieneck-Str. 5, 97816 Lohr, Germany.
Department of Neurology, Hospital Main-Spessart, Grafen-von-Rieneck-Str. 5, 97816 Lohr, Germany; Department of Neurology, University Clinic Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105498. doi: 10.1016/j.jstrokecerebrovasdis.2020.105498. Epub 2020 Dec 8.
Since the implementation of mechanical thrombectomy (MT) in 2015 for patients with ischemic stroke and large-vessel occlusion, the question arose as to whether patients should be primarily admitted to the nearest regional stroke unit (SU) for prompt intravenous thrombolysis (IVT) or to a more distant supraregional SU performing MT, to avoid secondary-transfer delays in MT. Although an evidence-based answer is still lacking, a discrepant discussion with potential consequences for the regional flow of stroke patients arose. We aimed to assess if MT implementation was associated with the number and characteristics of patients with stroke/transient ischemic attack (TIA) admitted to a regional SU not offering endovascular treatment.
Patients with acute stroke/TIA treated at the Klinikum Main-Spessart Lohr, Germany, in 2013/2014 or 2017/2018 were included in this retrospective study. Data were derived from the clinical information system and mandatory stroke quality assessment. We assessed the catchment area using a region-based approach. For each region, the number of patients treated in our hospital, including data regarding clinical severity, demographic characteristics, and changes over time, were analyzed.
The number of patients with acute stroke/TIA increased from 890 (2013/2014) to 1016 (2017/2018). Aggregated demographic and clinical data of the whole catchment area showed no differences between 2013/2014 and 2017/2018 (P > 0.05) besides duration of hospitalization (P < 0.01), IVT rate (P < 0.01), and secondary transfer for MT. A region-based analysis revealed an increase in younger and more severely affected patients admitted from the periphery of the catchment area between 2013/2014 and 2017/2018.
Despite the implementation of MT in the supraregional SUs around our regional SU (not offering MT), more patients with stroke/TIA were admitted to our hospital, especially younger and more severely affected patients, from the border regions of the catchment area.
自2015年对缺血性卒中和大血管闭塞患者实施机械取栓术（MT）以来，出现了一个问题，即患者应首先被收治到最近的区域卒中单元（SU）进行及时的静脉溶栓（IVT），还是被收治到距离更远但能进行MT的超区域SU，以避免MT的二次转运延误。尽管仍缺乏基于证据的答案，但围绕这一问题展开了有分歧的讨论，这可能会对卒中患者的区域流动产生影响。我们旨在评估MT的实施是否与未提供血管内治疗的区域SU收治的卒中/短暂性脑缺血发作（TIA）患者的数量及特征相关。
纳入2013/2014年或2017/2018年在德国洛尔市Main-Spessart医院接受治疗的急性卒中/TIA患者，进行这项回顾性研究。数据来源于临床信息系统和强制性卒中质量评估。我们采用基于区域的方法评估了服务区域。分析了每个区域在我院接受治疗的患者数量，包括临床严重程度、人口统计学特征及随时间的变化数据。
急性卒中/TIA患者数量从2013/2014年的890例增加到2017/2018年的1016例。除住院时间（P<0.01）、IVT率（P<0.01）和MT二次转运外，2013/2014年和2017/2018年整个服务区域的综合人口统计学和临床数据无差异（P>0.05）。基于区域的分析显示，2013/2014年至2017/2018年期间，从服务区域周边收治的年轻及病情更严重的患者有所增加。
尽管在我们区域SU周围的超区域SU实施了MT（我们区域SU不提供MT），但更多的卒中/TIA患者，尤其是年轻及病情更严重的患者，从服务区域的边界地区被收治到我院。
