Stroke Centre, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
Eur J Neurol. 2022 Sep;29(9):2674-2682. doi: 10.1111/ene.15415. Epub 2022 Jun 6.
In-hospital strokes (IHS) are associated with longer diagnosis times, treatment delays and poorer outcomes. Strokes occurring in the stroke unit have seldom been studied. Our aim was to assess the management of in-stroke-unit ischaemic stroke (ISUS) by analysing ISUS characteristics, delays in diagnosis, treatments and outcomes.
Consecutive patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL), from January 2003 to June 2019, were classified as ISUS, other-IHS or community-onset stroke (COS). Baseline and stroke characteristics, time to imaging and time to treatment, missed treatment opportunities, treatment rates and outcomes were compared using multivariate analysis with adjustment for relevant clinical, imaging and laboratory data available in ASTRAL.
Amongst the 3456 patients analysed, 138 (4.0%) were ISUS, 214 (6.2%) other-IHS and 3104 (89.8%) COS. In multivariate analysis, patients with ISUS more frequently had known stroke onset time than other-IHS (adjusted odds ratio [aOR] 2.44; 95% confidence interval [CI] 1.39-4.35) or COS (aOR 2.56; 95% CI 1.59-4.17), had fewer missed treatment opportunities than other-IHS (aOR 0.22; 95% CI 0.06-0.86) and higher endovascular treatment (EVT) rates than COS (aOR 3.03; 95% CI 1.54-5.88). ISUS was associated with a favourable shift in the modified Rankin Scale at 3 months in comparison with other-IHS (aOR 1.73; 95% CI 1.11-2.69) or COS (aOR 1.46; 95% CI 1.00-2.12).
In-stroke-unit ischaemic stroke more frequently had known stroke onset time than other-IHS or COS, fewer missed treatment opportunities than other-IHS and a higher EVT rate than COS. This readiness to identify and treat patients in the stroke unit may explain the better long-term outcome of ISUS.
院内卒中（IHS）与更长的诊断时间、治疗延迟和更差的结局相关。卒中单元内发生的卒中很少被研究。我们的目的是通过分析卒中单元内缺血性卒中（ISUS）的特点、诊断延迟、治疗和结局来评估其管理。
连续纳入 2003 年 1 月至 2019 年 6 月期间急性卒中登记和分析洛桑（ASTRAL）中的患者，根据卒中发生在卒中单元内、其他院内或社区起病分为 ISUS、其他-IHS 或社区起病性卒中（COS）。使用多变量分析比较基线和卒中特征、影像学和治疗时间、错失的治疗机会、治疗率和结局，并对 ASTRAL 中可用的相关临床、影像学和实验室数据进行调整。
在 3456 例患者中，138 例（4.0%）为 ISUS，214 例（6.2%）为其他-IHS，3104 例（89.8%）为 COS。多变量分析显示，与其他-IHS 或 COS 相比，ISUS 患者更常报告已知卒中发病时间（调整优势比[aOR] 2.44；95%置信区间[CI] 1.39-4.35），错失的治疗机会更少（aOR 0.22；95% CI 0.06-0.86），接受血管内治疗（EVT）的比例更高（aOR 3.03；95% CI 1.54-5.88）。与其他-IHS 或 COS 相比，ISUS 在 3 个月时改良 Rankin 量表评分的改善更明显（aOR 1.73；95% CI 1.11-2.69）。
与其他-IHS 或 COS 相比，卒中单元内发生的 ISUS 更常报告已知卒中发病时间，错失的治疗机会更少，EVT 率更高。这种在卒中单元内识别和治疗患者的准备可能解释了 ISUS 更好的长期结局。
