Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Department of Neurology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
Eur J Neurol. 2021 Dec;28(12):4031-4038. doi: 10.1111/ene.15107. Epub 2021 Sep 23.
We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome.
We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014-2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke.
Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12-19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38-90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: -0.49 min/annual referral, 95% confidence interval [CI]: -1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: -0.34 min/annual referral, 95% CI: -0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96-1.01).
In patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.
我们研究了初级卒中中心（PSC）转介行血管内治疗（EVT）的急性缺血性卒中患者的年就诊量与治疗时间和功能结局之间的关系。
我们使用了荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN）登记处（2014-2017 年）的数据。我们纳入了从 PSC 转至综合卒中中心（CSC）行 EVT 的前循环急性缺血性卒中患者。我们使用多变量回归模型，研究了 PSC 的 EVT 转介量与治疗时间和功能结局之间的关系。主要结局为从 PSC 到达股动脉穿刺部位的时间（PSC 门到股动脉时间），并校正了估计的救护车行驶时间；从 CSC 到达股动脉穿刺部位的时间（CSC 门到股动脉时间）；以及卒中后 90 天的改良 Rankin 量表（mRS）评分。
在登记处的 3637 例患者中，有 65 个 PSC 的 1541 例患者（42%）纳入研究。患者平均年龄为 71 岁（标准差±13.3），中位美国国立卫生研究院卒中量表评分 16 分（四分位距：12-19 分），自卒中发病至到达 PSC 的中位时间为 53 分钟（四分位距：38-90 分钟）。83%的患者接受了静脉溶栓治疗。EVT 转介量与 PSC 门到股动脉时间（校正后系数：-0.49 分钟/年转介量，95%置信区间：-1.27 至 0.29）、CSC 门到股动脉时间（校正后系数：-0.34 分钟/年转介量，95%置信区间：-0.69 至 0.01）或 90 天 mRS 评分（校正后比值比：0.99，95%置信区间：0.96-1.01）均无相关性。
在从 PSC 转至行 EVT 的患者中，较高的 PSC 就诊量似乎并未转化为更好的工作流程指标或患者结局。
