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非工作时间服务中疑似短暂性脑缺血发作(TIA)或中风患者的呼叫特征:男性与女性的比较

Call Characteristics of Patients Suspected of Transient Ischemic Attack (TIA) or Stroke During Out-of-Hours Service: A Comparison Between Men and Women.

作者信息

Exalto Lieza G, van Doorn Sander, Erkelens D Carmen A, Smit Karin, Rutten Frans H, Kappelle L Jaap, Zwart Dorien L M

机构信息

Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

出版信息

Front Neurol. 2021 Jun 14;12:669090. doi: 10.3389/fneur.2021.669090. eCollection 2021.

Abstract

In the Netherlands, a digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC) is used. Differences in help-seeking behavior between men and women when transient ischemic attack (TIA) or stroke is suspected could potentially affect telephone triage and allocation of urgency. To assess patient and call characteristics and allocated urgencies between women and men who contacted OHS-PC with suspected TIA/stroke. A cross-sectional study of 1,266 telephone triage recordings of subjects with suspected neurological symptoms calling the OHS-PC between 2014 and 2016. The allocated urgencies were derived from the electronic medical records of the OHS-PC and the final diagnosis from the patient's own general practitioner, including diagnoses based on hospital specialist letters. Five hundred forty-six men (mean age = 67.3 ± 17.1) and 720 women (mean age = 69.6 ± 19.5) were included. TIA/stroke was diagnosed in 294 men (54%) (mean age = 72.3 ± 13.6) and 366 women (51%) (mean age = 78.0 ± 13.8). In both genders, FAST (face-arm-speech test) symptoms were common in TIA/stroke (men 78%, women 82%) but also in no TIA/stroke (men 63%, women 62%). Men with TIA/stroke had shorter call durations than men without TIA/stroke (7.10 vs. 8.20 min, = 0.001), whereas in women this difference was smaller and not significant (7.41 vs. 7.56 min, = 0.41). Both genders were allocated high urgency in 75% of the final TIA/stroke cases. Overall, patient and call characteristics are mostly comparable between men and women, and these only modestly assist in identifying TIA/stroke. There were no gender differences in allocated urgencies after telephone triage in patients with TIA/stroke.

摘要

在荷兰,初级医疗非工作时间服务(OHS-PC)中使用了一种用于电话分诊的数字决策支持系统。当怀疑有短暂性脑缺血发作(TIA)或中风时,男性和女性在寻求帮助行为上的差异可能会影响电话分诊和紧急程度的分配。为了评估疑似TIA/中风而联系OHS-PC的男性和女性患者的特征、通话特点以及分配的紧急程度。对2014年至2016年期间拨打OHS-PC且有疑似神经症状的受试者的1266份电话分诊记录进行了横断面研究。分配的紧急程度来自OHS-PC的电子病历,最终诊断来自患者自己的全科医生,包括基于医院专科医生信件的诊断。纳入了546名男性(平均年龄=67.3±17.1岁)和720名女性(平均年龄=69.6±19.5岁)。294名男性(54%)(平均年龄=72.3±13.6岁)和366名女性(51%)(平均年龄=78.0±13.8岁)被诊断为TIA/中风。在男性和女性中,FAST(面部-手臂-言语测试)症状在TIA/中风患者中都很常见(男性78%,女性82%),但在无TIA/中风患者中也很常见(男性63%,女性62%)。患有TIA/中风的男性通话时间比未患TIA/中风的男性短(7.10分钟对8.20分钟,P=0.001),而在女性中这种差异较小且不显著(7.41分钟对7.56分钟,P=0.41)。在最终诊断为TIA/中风的病例中,75%的男性和女性都被分配了高紧急程度。总体而言,男性和女性的患者及通话特征大多具有可比性,这些特征对识别TIA/中风的帮助有限。TIA/中风患者电话分诊后分配的紧急程度没有性别差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3fea/8238082/a4def4b72f33/fneur-12-669090-g0001.jpg

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