特发性颅内高压症的跨学科综合专科一站式门诊——临床结局的综合评估。
An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension-a comprehensive assessment of clinical outcome.
机构信息
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Comprehensive Centre for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
出版信息
Eur J Neurol. 2024 Oct;31(10):e16401. doi: 10.1111/ene.16401. Epub 2024 Aug 16.
BACKGROUND AND PURPOSE
Management of idiopathic intracranial hypertension (IIH) is complex requiring multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges for healthcare professionals and patients. Thus, an interdisciplinary integrated outpatient clinic for IIH (comprising neurology, neuroophthalmology, neuroradiology, neurosurgery and endocrinology) was established with central coordination and a one-stop concept. Here, the aim was to evaluate the effects of this one-stop concept on objective clinical outcome.
METHODS
In a retrospective cohort study, the one-stop era with integrated care (IC) (1 July 2021 to 31 December 2022) was compared to a reference group receiving standard care (SC) (1 July 2018 to 31 December 2019) regarding visual impairment/worsening and headache improvement/freedom 6 months after diagnosis. Multivariate binary logistic regression models were used to adjust for confounders.
RESULTS
Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female 90.6% vs. 90.1%; mean age 33.6 vs. 32.8 years; median body mass index 31.8 vs. 33.0; median cerebrospinal fluid opening pressure 32 vs. 34 cmHO; at diagnosis, visual impairment was present in 71.8% vs. 69.1% and chronic headache in 55.3% vs. 56.8% in IC vs. SC). IC was associated with a higher likelihood of achieving both headache improvement (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.52-4.33, p < 0.001) and headache freedom (OR 1.75, 95% CI 1.11-3.09, p = 0.031). Regarding the risk of visual impairment and visual worsening IC was superior numerically but not statistically significantly (OR 0.87, 95% CI 0.69-1.16, p = 0.231, and OR 0.67, 95% CI 0.41-1.25, p = 0.354).
CONCLUSIONS
Interdisciplinary integrated care of IIH is favourably associated with headache outcomes and potentially also visual outcomes.
背景与目的
特发性颅内高压症（IIH）的管理较为复杂，需要多个专业学科的共同参与。实际上，这给医疗保健专业人员和患者带来了相当大的组织和沟通方面的挑战。因此，我们成立了一个由神经科、神经眼科、神经放射科、神经外科和内分泌科组成的 IIH 多学科综合门诊（IDH），并配备了中央协调和一站式服务的理念。这里，我们旨在评估这种一站式服务理念对客观临床结局的影响。
方法
在一项回顾性队列研究中，我们将综合治疗（IC）时代（2021 年 7 月 1 日至 2022 年 12 月 31 日）与标准治疗（SC）时代（2018 年 7 月 1 日至 2019 年 12 月 31 日）进行了比较，主要评估指标为诊断后 6 个月时的视力损害/恶化和头痛改善/缓解。使用多变量二项逻辑回归模型对混杂因素进行调整。
结果
IC 组（n=85）和 SC 组（n=81）的基线特征相似（女性 90.6% vs. 90.1%；平均年龄 33.6 岁 vs. 32.8 岁；中位体重指数 31.8 公斤/米 2 vs. 33.0 公斤/米 2；中位脑脊液开放压力 32 厘米水柱 vs. 34 厘米水柱；在诊断时，71.8%的患者存在视力损害，55.3%的患者存在慢性头痛，IC 组和 SC 组分别占 71.8%和 55.3%）。IC 与更高的头痛改善（比值比 [OR] 2.24，95%置信区间 [CI] 1.52-4.33，p<0.001）和头痛缓解（OR 1.75，95%CI 1.11-3.09，p=0.031）的可能性相关。关于视力损害和视力恶化的风险，IC 在数值上优于但在统计学上无显著性差异（OR 0.87，95%CI 0.69-1.16，p=0.231，OR 0.67，95%CI 0.41-1.25，p=0.354）。
结论
IIH 的多学科综合治疗与头痛结局有关，可能也与视力结局有关。
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