Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2024 Oct;190:1-9. doi: 10.1016/j.wneu.2024.05.171. Epub 2024 Jun 1.
Of the 750,000 strokes in the United States every year, 15% patients suffer from hemorrhagic stroke. Intracerebral hemorrhage (ICH) is a subtype of hemorrhagic stroke. Despite advances in acute management, patients with hemorrhagic stroke continue to suffer from high mortality and survivors suffer from multidomain impairments in the physical, cognitive, and mental health domains which could last for months to years from their index stroke. Long-term prognosis after ICH is critically dependent on the quality and efficacy of care a patient receives during the acute phase of care. With ongoing care consolidation in stroke systems of care, the number of ICH patients who need to undergo interhospital transfers (IHTs) is increasing. However, the associations between IHT and ICH outcomes have not been well described in literature. In this review, we describe the epidemiology of IHT for ICH, the relationship between IHT and ICH patient outcomes, and proposed improvements to the IHT process to ensure better long-term patient outcomes. Our review indicates that evidence regarding the safety and benefit of IHT for ICH patients is conflicting, with some studies reporting poorer outcomes for transferred patients compared to direct admissions via emergency rooms and other studies showing no effect on outcomes. The American Heart Association guidelines for ICH provide recommendations for timely blood pressure control and anticoagulation reversal to improve patient outcomes. The American Heart Association stroke systems of care guidelines provide recommendations for transfer agreements and but do not provide details on how patients should be managed while undergoing IHT. Large, prospective, and multicenter studies comparing outcomes of IHT patients to direct admissions are necessary to provide more definitive guidance to optimize IHT protocols and aid clinical decision-making.
在美国每年发生的 75 万例中风中，15%的患者患有出血性中风。脑出血（ICH）是出血性中风的一种亚型。尽管急性治疗取得了进展，但出血性中风患者的死亡率仍然很高，幸存者在身体、认知和心理健康等多个领域仍存在多方面的障碍，这些障碍可能会持续数月至数年。ICH 后的长期预后严重依赖于患者在急性治疗期间接受的护理质量和效果。随着卒中护理系统中持续护理的整合，需要进行院际转院（IHT）的 ICH 患者数量不断增加。然而，IHT 与 ICH 患者结局之间的关联在文献中尚未得到很好的描述。在这篇综述中，我们描述了 ICH 患者 IHT 的流行病学、IHT 与 ICH 患者结局之间的关系，以及为确保更好的长期患者结局而提出的 IHT 流程改进措施。我们的综述表明，关于 IHT 对 ICH 患者的安全性和益处的证据存在矛盾，一些研究报告转院患者的结局较差，而另一些研究则表明对结局没有影响。美国心脏协会（AHA）ICH 指南提供了关于及时控制血压和抗凝逆转以改善患者结局的建议。AHA 卒中护理系统指南提供了转院协议的建议，但没有详细说明患者在进行 IHT 期间应如何管理。有必要进行大规模、前瞻性和多中心研究，比较 IHT 患者和直接入院患者的结局，以提供更明确的指导，优化 IHT 方案并辅助临床决策。
