Khosravani Houman, Mahendiran Meera, Sivanandan Brindan, Gardner Sandra, Saposnik Gustavo, Brookes Jahnel, Berall Anna, Perri Giulia-Anna
Hurvitz Brain Sciences Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Neurology Quality and Innovation Lab (NQIL), Division of Neurology, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
Am J Hosp Palliat Care. 2025 Mar;42(3):273-281. doi: 10.1177/10499091241253538. Epub 2024 May 9.
Palliative care (PC) aims to enhance the quality of life for patients when confronted with serious illness. As stroke inflicts high morbidity and mortality, the integration of PC within acute stroke care remains an important aspect of quality inpatient care. However, there is a tendency to offer PC to stroke patients only when death appears imminent. We aim to understand why this may be by examining stroke patients admitted to a regional stroke centre who subsequently died and their provision of PC. We conducted a retrospective single-centre cohort study of patients who died during admission to the regional stroke centre at Sunnybrook Health Sciences Centre (SHSC) in Toronto, Ontario, Canada. Baseline demographics were assessed using means, standard deviations (SD), medians, interquartile ranges (IQR), and proportions. Descriptive statistics, univariate, and multivariate analyses were performed to ascertain relationships between collected variables. Univariate modeling demonstrated that older age, being female, no stroke diagnosis at admission to hospital, ischemic stroke, and comorbidities of cancer or dementia were associated with a higher incidence of palliative medicine consultation (PMC), while admission from an acute care hospital and a Glasgow Coma Scale (GCS) coma classification were associated with a lower incidence of PMC. The multivariate model identified the GCS coma-related category as the only significant factor associated with a higher incidence of death but was non-significantly related to a lower incidence of PMC. These results highlight continued missed opportunities for PC in stroke patients and underscore the need to better optimize PMC.
姑息治疗（PC）旨在提高面临严重疾病患者的生活质量。由于中风导致高发病率和死亡率，将姑息治疗纳入急性中风护理仍是优质住院护理的一个重要方面。然而，存在一种倾向，即仅在死亡似乎迫在眉睫时才为中风患者提供姑息治疗。我们旨在通过研究入住某地区中风中心随后死亡的中风患者及其姑息治疗的提供情况，来了解为何会出现这种情况。我们对在加拿大多伦多安大略省桑尼布鲁克健康科学中心（SHSC）的地区中风中心住院期间死亡的患者进行了一项回顾性单中心队列研究。使用均值、标准差（SD）、中位数、四分位数间距（IQR）和比例对基线人口统计学数据进行评估。进行描述性统计、单变量和多变量分析以确定所收集变量之间的关系。单变量模型表明，年龄较大、女性、入院时未诊断为中风、缺血性中风以及患有癌症或痴呆症合并症与姑息医学会诊（PMC）的较高发生率相关，而从急性护理医院入院和格拉斯哥昏迷量表（GCS）昏迷分级与PMC的较低发生率相关。多变量模型确定GCS昏迷相关类别是与较高死亡率相关的唯一显著因素，但与较低的PMC发生率无显著关联。这些结果凸显了中风患者姑息治疗持续存在的机会错失，并强调了更好地优化姑息医学会诊的必要性。
