Department of Neurology, Jose R Reyes Memorial Medical Center, Manila City, Philippines.
St. Luke's Medical Center, Institute of Neurosciences, Quezon City, Philippines.
Int J Stroke. 2021 Oct;16(7):849-854. doi: 10.1177/1747493020981730. Epub 2021 Jan 7.
In high-income countries, the management of stroke has changed substantially over the years with the advent of thrombolysis and endovascular treatment. However, in low-income countries, such interventions may not be available, or patients may come to the hospital outside the time window no longer qualified for this therapy. Most studies on stroke units were conducted in high-income countries. Unfortunately, there has been no local multicenter data with large patient numbers showing the effectiveness of stroke units in the Southeast Asian region.
To compare the outcomes of patients allocated to stroke units (based on accepted criteria) to those allocated to general neurology wards in the Philippines.
This is an open, prospective, parallel, observational comparative study of patients from 11 institutions in the Philippines. Patients were allocated either to the stroke unit or to the general neurology ward by the admitting physician based on the criteria suggested by the Stroke Trialist Collaboration Group. The primary outcome was to determine in-hospital mortality at three- and six months in both stroke units and general neurology wards. The secondary outcomes were determined by a dichotomized modified Rankin scale: (0-2) independent and (3-5) dependent.
A total of 1025 patients were included in the study. In the primary outcome, a higher mortality rate (8.4% vs 1.0%) in the general neurology ward (p = 0.000) was seen. The six-month mortality rate was statistically significant and higher among patients admitted to the general neurology ward (3.1% vs 0.8%) (p = 0.009). Patients admitted to the stroke unit attained an independent functional outcome (mRS 0-2) as compared to the general neurology ward (73% vs 61.5%) (p = 0.000). Analysis of functionality at six months favored patients admitted in the stroke unit (88.5% vs 81.4%) as compared to the general neurology ward.
Patients specifically admitted to stroke units in the Philippines based on established criteria have better outcomes than those admitted to general neurology wards.
在高收入国家，随着溶栓和血管内治疗的出现，多年来中风的治疗方式发生了重大变化。然而，在低收入国家，这些干预措施可能无法提供，或者患者可能在不符合该治疗条件的时间窗口之外来到医院。大多数关于卒中单元的研究都是在高收入国家进行的。不幸的是，没有来自东南亚地区的大量患者的当地多中心数据显示卒中单元的有效性。
比较在菲律宾分配到卒中单元（基于公认标准）的患者与分配到普通神经科病房的患者的结果。
这是一项在菲律宾 11 家机构进行的开放性、前瞻性、平行、观察性比较研究。根据卒中试验协作组建议的标准，由主治医生将患者分配到卒中单元或普通神经科病房。主要结局是确定卒中单元和普通神经科病房患者在 3 个月和 6 个月时的院内死亡率。次要结局通过二分法修改后的 Rankin 量表确定：（0-2）独立和（3-5）依赖。
共有 1025 名患者纳入研究。在主要结局方面，普通神经科病房的死亡率较高（8.4%对 1.0%）（p=0.000）。6 个月时的死亡率有统计学意义，普通神经科病房的死亡率更高（3.1%对 0.8%）（p=0.009）。与普通神经科病房相比，入住卒中单元的患者获得了独立的功能结局（mRS 0-2）（73%对 61.5%）（p=0.000）。6 个月时的功能分析结果也有利于入住卒中单元的患者（88.5%对 81.4%）。
根据既定标准专门入住菲律宾卒中单元的患者比入住普通神经科病房的患者有更好的结局。
