每周一次的神经血管多学科会议讨论后，各专科之间达成共识的决策频率和对建议的遵从情况。
Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting.
机构信息
Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
出版信息
Ir J Med Sci. 2023 Dec;192(6):3051-3062. doi: 10.1007/s11845-023-03319-4. Epub 2023 Apr 21.
BACKGROUND/AIMS: Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM 'adherence' to such advice.
METHODS
This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom 'consensus management decisions' were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), 'indeterminate symptomatic status stenosis' (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / - intervention.
RESULTS
One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50-99% SCS patients was 12.5 days (IQR: 9-18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1-7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up.
CONCLUSIONS
The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death.
背景/目的：关于颅外颈动脉/椎动脉狭窄患者的管理，参加神经血管多学科会议（MDM）的亚专科医生之间“共识决策”的频率以及 MDM 后的“依从性”的数据有限。
方法
本前瞻性审核/质量改进项目前瞻性地从每周的神经血管/中风中心 MDM 记录中收集数据，记录神经科医生、血管外科医生、中风医生-老年病学家和神经放射科医生之间就颅外颈动脉/椎动脉狭窄患者达成“共识管理决策”的比例。在无症状性颈动脉狭窄（ACS）、症状性颈动脉狭窄（SCS）、“不确定症状性狭窄”（ISS）和椎动脉狭窄（VAS）患者中分析了对 MDM 建议的依从性，包括从指数事件到 MDM+/-干预的间隔时间。
结果
共讨论了 115 例患者：108 例为颈动脉狭窄，7 例为椎动脉狭窄。在 96.5%（111/115）的患者中达成了管理共识：100%的 ACS 和 VAS 患者、96.2%的 SCS 患者和 92.9%的 ISS 患者。对 MDM 管理建议的依从性为 96.4%（107/111）：ACS、ISS 和 VAS 患者为 100%；SCS 患者为 92%（46/50）。50-99%SCS 患者的指数症状到血运重建的中位数间隔为 12.5 天（IQR：9-18.3 天；N=26），从 MDM 到血运重建的中位数间隔为 5.5 天（IQR：1-7 天）。30 例患者接受了血运重建。29 例 SCS 或 ISS 患者中有 2 例（6.9%）出现同侧缺血性卒中，在 3 个月随访期间无进一步的卒中/死亡。
结论
在管理方面，各专科之间达成共识的频率很高，对提出的治疗方案的依从性也很高，这支持了对颅外动脉狭窄患者进行协作/多学科治疗模式。服务发展应旨在缩短 MDM 讨论-干预之间的时间，并优化预防卒中/死亡。
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