Envision Physician Services, Plantation, FL, USA.
Polk County Fire Rescue, Bartow, FL, USA.
J Osteopath Med. 2023 Apr 13;123(7):331-336. doi: 10.1515/jom-2022-0191. eCollection 2023 Jul 1.
Stroke is one of the largest healthcare burdens in the United States and globally. It continues to be one of the leading causes of morbidity and mortality. Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (BP).
The objective of our study was to evaluate the association of systolic blood pressure (SBP) in the emergency department (ED) with stroke severity in patients with AIS.
This observational study was conducted at an ED with an annual census of 80,000 visits, approximately half (400) of which are for AIS. The cohort consisted of adult patients who presented to the ED within 24 h of stroke symptom onset. BP was measured at triage by a nurse blinded to the study. Stroke severity was measured utilizing the National Institutes of Health Stroke Scale (NIHSS). Statistical analyses were performed utilizing JMP 14.0. This study was approved by our medical school's institutional review board.
Patients with higher SBP had significantly lower NIHSS scores (p=0.0038). This association was significant even after adjusting for age and gender. By contrast, diastolic blood pressure (DBP) did not appear to impact stroke severity. There was no difference in the DBP values between men and women. Higher SBP was also significantly associated with being discharged home as well as being less likely to die in the hospital or discharged to hospice. The DBP did not demonstrate this association. Neither the SDP nor the DBP were significantly associated with the hospital length of stay (LOS). In multivariate models that included age, gender, basal metabolic index (BMI), comorbidities, and ED presentation, elevated SBP was associated with better prognosis.
In this cohort of patients presenting with stroke-like symptoms to the ED, higher SBP was associated with lower stroke severity and higher rates of being discharged to home rather than hospice or death.
中风是美国和全球医疗保健最大的负担之一。它仍然是发病率和死亡率的主要原因之一。急性缺血性中风（AIS）患者的血压通常升高。
我们的研究目的是评估急诊室（ED）收缩压（SBP）与 AIS 患者中风严重程度的关系。
这项观察性研究在一个每年就诊人数为 80000 人的 ED 进行，其中大约一半（400 人）是 AIS。队列由中风症状发作后 24 小时内到 ED 就诊的成年患者组成。护士在分诊时测量血压，对研究不知情。中风严重程度采用国立卫生研究院中风量表（NIHSS）进行测量。统计分析采用 JMP 14.0。这项研究得到了我们医学院机构审查委员会的批准。
SBP 较高的患者 NIHSS 评分明显较低（p=0.0038）。即使在调整年龄和性别后，这种关联仍然显著。相比之下，舒张压（DBP）似乎并不影响中风严重程度。男性和女性的 DBP 值没有差异。较高的 SBP 也与出院回家以及在医院内死亡或出院到临终关怀的可能性降低显著相关。DBP 没有显示出这种关联。SBP 和 DBP 均与住院时间长短（LOS）无显著关联。在包括年龄、性别、基础代谢指数（BMI）、合并症和 ED 表现的多变量模型中，SBP 升高与预后更好相关。
在这个向 ED 就诊的有中风样症状的患者队列中，较高的 SBP 与较低的中风严重程度和更高的出院回家而不是临终关怀或死亡的几率相关。
