Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Sci Rep. 2022 Feb 28;12(1):3252. doi: 10.1038/s41598-022-06074-1.
To determine whether increasing thrombectomy-capable hospitals with moderate comprehensive stroke center (CSC) capabilities is a valid alternative to centralization of those with high CSC capabilities. This retrospective, nationwide, observational study used data from the J-ASPECT database linked to national emergency medical service (EMS) records, captured during 2013-2016. We compared the influence of mechanical thrombectomy (MT) use, the CSC score, and the total EMS response time on the modified Rankin Scale score at discharge among patients with acute ischemic stroke transported by ambulance, in phases I (2013-2014, 1461 patients) and II (2015-2016, 3259 patients). We used ordinal logistic regression analyses to analyze outcomes. From phase I to II, MTs increased from 2.7 to 5.5%, and full-time endovascular physicians per hospital decreased. The CSC score and EMS response time remained unchanged. In phase I, higher CSC scores were associated with better outcomes (1-point increase, odds ratio [95% confidence interval]: 0.951 [0.915-0.989]) and longer EMS response time was associated with worse outcomes (1-min increase, 1.007 [1.001-1.013]). In phase II, neither influenced the outcomes. During the transitional shortage of thrombectomy-capable hospitals, increasing hospitals with moderate CSC scores may increase nationwide access to MT, improving outcomes.
为了确定增加具有中等综合卒中中心（CSC）能力的血栓切除术医院是否是集中具有高 CSC 能力的医院的有效替代方案。本回顾性、全国性、观察性研究使用了 2013-2016 年期间从与国家紧急医疗服务（EMS）记录相关联的 J-ASPECT 数据库中获取的数据。我们比较了机械血栓切除术（MT）使用、CSC 评分和总 EMS 反应时间对通过救护车运送的急性缺血性卒中患者在出院时改良 Rankin 量表评分的影响，这些患者分为两个阶段（I 期：2013-2014 年，1461 例患者；II 期：2015-2016 年，3259 例患者）。我们使用有序逻辑回归分析来分析结果。从第一阶段到第二阶段，MT 从 2.7%增加到 5.5%，而每所医院全职血管内医师的数量减少。CSC 评分和 EMS 反应时间保持不变。在第一阶段，更高的 CSC 评分与更好的结果相关（增加 1 分，比值比[95%置信区间]：0.951[0.915-0.989]），而更长的 EMS 反应时间与更差的结果相关（增加 1 分钟，1.007[1.001-1.013]）。在第二阶段，这两个因素都没有影响结果。在血栓切除术医院短缺的过渡期间，增加具有中等 CSC 评分的医院可能会增加全国范围内接受 MT 的机会，从而改善结果。
