Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Denmark (J. Mackenhauer, J. Mainz, S.P.J.).
Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark (J. Mackenhauer, J. Mainz).
Stroke. 2022 Nov;53(11):3375-3385. doi: 10.1161/STROKEAHA.122.038591. Epub 2022 Aug 18.
Comorbid mental illness may delay recognition of stroke symptoms and reduce the chance of reperfusion therapy. The aim of this study was to compare the use of reperfusion therapy and treatment delays in patients with or without a history of mental illness.
A nationwide registry-based cohort study of patients with ischemic stroke. We combined data from the Danish Stroke Registry and the Danish Quality Database for Prehospital Emergency Medical Services from 2016 to 2017 containing information on reperfusion therapy (thrombolysis or thrombectomy) and relevant time stamps. Patients were categorized according to the severity of their mental health history (how recent and severity, for example, hospital- versus primary-based care).
A total of 19 592 admissions were included (18% had a minor, 3% had a moderate, and 3% had a history of major mental illness). Significant differences were found regarding age, comorbidity, and socioeconomic factors. Reperfusion therapy was used in 17% of patients. Patients with a history of mental illness were less likely to receive reperfusion therapy: risk ratios with 95% CI were 0.79 (0.72-0.86) for minor, 0.85 (0.72-0.99) for moderate, and 0.63 (0.51-0.77) for patients with a history major mental illness, respectively. Total prehospital delay was longer for patients with a history of major mental illness compared to patients with no history of mental illness, especially when no call had been made to the emergency medical service. The median times from symptom onset to hospital arrival was 811 minutes (197-2845) and 115 minutes (41-188), respectively. We found no differences regarding door-to-needle time, response time, on-scene time, transport time, nor in time-to-imaging among patients arriving within 4 hours from symptoms onset between patients with and without a history of mental illness.
Almost one-quarter of patients with ischemic stroke had a history of mental illness. Regardless of severity of mental illness, these patients were less likely to receive reperfusion therapy. Longer delays from symptom onset to hospital arrival contributed to the patients' risk of not being eligible for reperfusion therapy.
合并精神疾病可能会延迟对中风症状的识别，并降低再灌注治疗的机会。本研究的目的是比较有或无精神病史患者使用再灌注治疗和治疗延迟的情况。
一项基于全国登记的缺血性卒中患者队列研究。我们合并了来自丹麦卒中登记处和丹麦院前急救医疗服务质量数据库的数据，数据包含了再灌注治疗（溶栓或血栓切除术）和相关时间戳的信息。患者根据精神病史的严重程度进行分类（例如，最近的病史和严重程度，例如，住院或初级保健为基础的护理）。
共纳入 19592 例入院患者（18%有轻度、3%有中度、3%有重度精神病史）。在年龄、合并症和社会经济因素方面存在显著差异。17%的患者接受了再灌注治疗。有精神病史的患者接受再灌注治疗的可能性较小：风险比（95%CI）分别为 0.79（0.72-0.86）、0.85（0.72-0.99）和 0.63（0.51-0.77）。与无精神病史的患者相比，有精神病史的患者的总院前延迟时间更长，尤其是在未向急救医疗服务中心呼叫的情况下。从症状发作到入院的中位数时间分别为 811 分钟（197-2845 分钟）和 115 分钟（41-188 分钟）。我们发现，对于在症状发作后 4 小时内到达的患者，在门到针时间、反应时间、现场时间、转运时间和影像学检查时间方面，无精神病史的患者和有精神病史的患者之间没有差异。
近四分之一的缺血性卒中患者有精神病史。无论精神疾病的严重程度如何，这些患者接受再灌注治疗的可能性较低。从症状发作到入院的延迟时间延长，增加了患者不能接受再灌注治疗的风险。
