Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
Australas Emerg Care. 2021 Sep;24(3):167-173. doi: 10.1016/j.auec.2021.01.002. Epub 2021 Feb 26.
Hospital arrival via ambulance influences treatment of acute stroke. We aimed to determine the factors associated with use of ambulance and access to evidence-based care among patients with stroke.
Patients with first-ever strokes from the Australian Stroke Clinical Registry (2010-2013) were linked with administrative data (emergency, hospital admissions). Multilevel, multivariable regression models were used to determine patient, clinical and system factors associated with arrival by ambulance.
Among the 6,262 patients with first-ever stroke, 4,737 (76%) arrived by ambulance (52% male; 80% ischaemic). Patients who were older, frailer, with comorbidities or were unable to walk on admission (stroke severity) were more likely to arrive by ambulance to hospital. Compared to those using other means of transport, those who used ambulances arrived to hospital sooner after stroke onset (minutes, 124 vs 397) and were more likely to receive reperfusion therapy (adjusted odds ratio, 1.57, 95% CI: 1.09, 2.27).
Patients with stroke who use ambulances arrived faster and were more likely to receive reperfusion therapy compared to those using personal transport. Further public education about using ambulance services at all times, instead of personal transport when stroke is suspected is needed to optimise access to time critical care.
通过救护车到达医院会影响急性中风的治疗。我们旨在确定与中风患者使用救护车和获得循证治疗相关的因素。
来自澳大利亚中风临床登记处（2010-2013 年）的首次中风患者与行政数据（急诊、住院）相关联。使用多水平、多变量回归模型来确定与通过救护车到达相关的患者、临床和系统因素。
在 6262 名首次中风患者中，有 4737 名（76%）通过救护车到达（52%为男性；80%为缺血性）。年龄较大、身体更脆弱、合并症或入院时无法行走（中风严重程度）的患者更有可能通过救护车送往医院。与使用其他交通工具的患者相比，使用救护车的患者在中风发作后更快到达医院（分钟数，124 与 397），并且更有可能接受再灌注治疗（调整后的优势比，1.57，95%置信区间：1.09，2.27）。
与使用个人交通工具的患者相比，使用救护车的中风患者到达更快，并且更有可能接受再灌注治疗。需要进一步开展公众教育，让公众了解在任何时候都应使用救护车服务，而不是在怀疑中风时使用个人交通工具，以优化获得关键时间治疗的机会。
