Yang Huajie, Wu Zhuohua, Huang Xiang, Zhang Man, Fu Yu, Wu Yijuan, Liu Lei, Li Yiheng, Wang Harry H X
School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People's Republic of China.
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
Int J Gen Med. 2023 Jan 5;16:57-68. doi: 10.2147/IJGM.S371687. eCollection 2023.
Timely access to emergency treatment during in-hospital care phase is critical for managing the onset of acute ischaemic stroke (AIS), particularly in developing countries. We aimed to explore in-hospital emergency treatment delay and the relation of door-to-needle (DTN) time to ambulance arrivals vs walk-in arrivals.
Data were collected from 1276 Chinese AIS patients admitted to a general, tertiary-level hospital for intravenous thrombolysis. Information on patients' characteristics and time taken during in-hospital emergency treatment was retrieved from the hospital registry data and medical records. Ambulance arrival was defined as being transported by emergency ambulance services, while walk-in arrival was defined as arriving at hospital by regular vehicle. In-hospital emergency treatment delay occurred when the DTN time exceeded 60 minutes. We performed multivariable logistic regression analysis to explore the association between hospital arrivals (by ambulance vs by walk-in) and treatment delay after adjustment for age, sex, education, marital status, residence, medical insurance, number of symptoms, clinical severity and survival outcome.
Over half (53.76%) of patients aged over 60 years. Around one-fifth (20.61%) of patients admitted to hospital through emergency ambulance services, while their counterparts arrived by regular vehicle. Overall, the median time taken from the hospital door to treatment initiation was 86.0 minutes. Patients arrived by ambulance (adjusted odds ratio [aOR] = 1.744, 95% confidence interval [CI] = 1.185-2.566, = 0.005), had higher socio-economic status (aOR = 1.821, 95% CI = 1.251-2.650; = 0.002), or paid out-of-pocket (aOR = 2.323, 95% CI = 1.764-3.060; < 0.001) had an increased likelihood of in-hospital emergency treatment delays.
In-hospital emergency treatment delay is common in China, and occurs throughout the entire emergency treatment journey. Having a triage pathway involving hospital arrival by ambulance seems to be more likely to experience in-hospital emergency treatment delay. Further efforts to improve triage pathways may require qualitative evidence on provider- and institutional-level factors associated with in-hospital emergency treatment delay.
在住院治疗阶段及时获得紧急治疗对于管理急性缺血性卒中（AIS）的发病至关重要，尤其是在发展中国家。我们旨在探讨住院紧急治疗延迟以及从入院到开始溶栓（DTN）时间与救护车送达患者和步行入院患者的关系。
收集了1276例入住一家三级综合医院接受静脉溶栓治疗的中国AIS患者的数据。从医院登记数据和病历中获取患者特征信息以及住院紧急治疗期间所花费的时间。救护车送达定义为由紧急救护服务运送，而步行入院定义为乘坐常规车辆到达医院。当DTN时间超过60分钟时即发生住院紧急治疗延迟。我们进行了多变量逻辑回归分析，以探讨在调整年龄、性别、教育程度、婚姻状况、居住地、医疗保险、症状数量、临床严重程度和生存结局后，入院方式（救护车送达与步行入院）与治疗延迟之间的关联。
超过一半（53.76%）的患者年龄超过60岁。约五分之一（20.61%）的患者通过紧急救护服务入院，而其余患者乘坐常规车辆入院。总体而言，从入院到开始治疗的中位时间为86.0分钟。通过救护车入院的患者（调整后的优势比[aOR]=1.744，95%置信区间[CI]=1.185 - 2.566，P = 0.005）、社会经济地位较高的患者（aOR = 1.821，95% CI = 1.251 - 2.650；P = 0.002）或自费患者（aOR = 2.323，95% CI = 1.764 - 3.060；P < 0.001）发生住院紧急治疗延迟的可能性增加。
住院紧急治疗延迟在中国很常见，且在整个紧急治疗过程中均有发生。采用涉及救护车入院的分诊途径似乎更有可能出现住院紧急治疗延迟。进一步改善分诊途径的努力可能需要关于与住院紧急治疗延迟相关的提供者和机构层面因素的定性证据。
