Hastrup Sidsel, Johnsen Soren P, Jensen Martin, von Weitzel-Mudersbach Paul, Simonsen Claus Z, Hjort Niels, Møller Anette T, Harbo Thomas, Poulsen Marika S, Iversen Helle K, Damgaard Dorte, Andersen Grethe
From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark.
Neurology. 2021 Feb 22;96(8):e1096-e1109. doi: 10.1212/WNL.0000000000011453.
To evaluate the effects of an outpatient clinic setup for minor stroke/TIA using subsequent admission of patients at high risk of recurrent stroke.
We performed a cohort study of all patients with suspected minor stroke/TIA seen in an outpatient clinic at Aarhus University Hospital, Denmark, between September 2013 and August 2014. Patients with stroke were compared to historic (same hospital) and contemporary (another comparable hospital) matched, hospitalized controls on nonprioritized outcomes: length of stay, readmissions, care quality (10 process-performance measures), and mortality. Patients with TIA were compared to contemporary matched, hospitalized controls. Following complete diagnostic workup, patients with stroke/TIA were classified into low/high risk of recurrent stroke ≤7 days.
We analyzed 1,076 consecutive patients, of whom 253 (23.5%) were subsequently admitted to the stroke ward. Stroke/TIA was diagnosed in 215/171 patients, respectively. Fifty-six percent (121/215) of the patients with stroke were subsequently admitted to the stroke ward. Comparison with the historic stroke cohort (n = 191) showed a shorter acute hospital stay for the strokes (median 1 vs 3 days; adjusted length of stay ratio 0.49; 95% confidence interval 0.33-0.71). Thirty-day readmission rate was 3.2% vs 11.6% (adjusted hazard ratio 0.23 [0.09-0.59]), and care quality was higher, with a risk ratio of 1.30 (1.15-1.47). The comparison of stroke and TIAs to contemporary controls showed similar results. Only one patient in the low risk category and not admitted experienced stroke within 7 days (0.6%).
An outpatient clinic setup for patients with minor stroke/TIA yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units.
This study provides Class III evidence that a neurovascular specialist-driven outpatient clinic for patients with minor stroke/TIA with the ability of subsequent admission is safe and yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units.
通过对复发性卒中高危患者的后续住院情况进行评估，以评价门诊模式对轻度卒中/短暂性脑缺血发作（TIA）的影响。
我们对2013年9月至2014年8月期间在丹麦奥胡斯大学医院门诊就诊的所有疑似轻度卒中/TIA患者进行了一项队列研究。将卒中患者与历史对照组（同一医院）和当代对照组（另一家类似医院）在非优先结局方面进行比较，这些结局包括住院时间、再入院情况、护理质量（10项过程绩效指标）和死亡率。将TIA患者与当代匹配的住院对照组进行比较。在完成全面的诊断检查后，将卒中/TIA患者分为复发性卒中≤7天的低/高风险组。
我们分析了1076例连续患者，其中253例（23.5%）随后被收入卒中病房。分别在215例/171例患者中诊断出卒中/TIA。56%（121/215）的卒中患者随后被收入卒中病房。与历史卒中队列（n = 191）相比，卒中患者的急性住院时间较短（中位数1天对3天；调整后的住院时间比为0.49；95%置信区间0.33 - 0.71）。30天再入院率为3.2%对11.6%（调整后的风险比为0.23 [0.09 - 0.59]），护理质量更高，风险比为1.30（1.15 - 1.47）。将卒中和TIA患者与当代对照组进行比较显示了类似的结果。低风险组中未入院的患者仅有1例在7天内发生卒中（0.6%）。
与卒中单元住院治疗相比，为轻度卒中/TIA患者设立的门诊模式可使急性住院时间缩短、再入院率降低且质量更高。
本研究提供了III级证据，即由神经血管专科医生主导的、具备后续收治能力的轻度卒中/TIA患者门诊模式是安全的，且与卒中单元住院治疗相比，可使急性住院时间缩短、再入院率降低且质量更高。
