因急性孤立性眩晕和平衡失调而被转诊进行脑溶栓治疗的院前患者。
Prehospital patients with acute isolated vertigo and imbalance referred for cerebral thrombolysis.
作者信息
De Schryver S R H, de Jonge M, van Luxemburg R P, Geraedts V J, De Schryver E L L M
机构信息
Department of Neurology, Alrijne Hospital, Leiderdorp, Netherlands.
Department of Neurology, LUMC, Leiden, Netherlands.
出版信息
Front Neurol. 2025 May 21;16:1561202. doi: 10.3389/fneur.2025.1561202. eCollection 2025.
INTRODUCTION
Patients with acute vertigo and gait imbalance who are suspected of having a stroke, are increasingly referred to the hospital for intravenous thrombolysis treatment (IVT) with an increasing impact on the healthcare consumption. This study seeks to examine the medical feasibility of considering patients suffering from acute vertigo with imbalance in a prehospital setting without other neurological symptoms as potential candidates for IVT regarding its efficacy and impact on clinical outcomes.
METHODS
Patients referred for IVT with isolated vertigo as determined by the ambulance paramedics, were retrospectively enrolled from a single center. Patients were categorized by discharge diagnosis. Baseline characteristics were recorded. The Modified Rankin Score (mRS) was used to assess clinical outcomes.
RESULTS
163 consecutive patients were included. Within this cohort, 5.5% were diagnosed with stroke, and 7.9% with suspected stroke. Among patients with (suspected) stroke, 59.1% received IVT. Among patients with (suspected) vestibular vertigo, 5.1% received IVT. Patients with (suspected) stroke exhibited higher National Institutes of Health Stroke Scale [NIHSS; Mdn 0 (Q1 0; Q3 1) and Mdn 2 (Q1 0; Q3 2.5)]. Additionally, walking ability did not significantly vary between patients with vestibular disease and stroke. The mRS scores after a 3-month period did not show significant differences between the groups.
CONCLUSION
Accurately differentiating between central and peripheral causes of vertigo in the hyperacute setting is challenging and carries the risk of overreferral and overtreatment. Combined with the lack of evidence that IVT improves clinical outcomes in patients with isolated vertigo and imbalance, and the increasing demand for healthcare, the authors suggest not referring these patients immediately for IVT but to consider adequate training of the paramedics in-field and other routes of medical assessment and treatment.
引言
怀疑中风的急性眩晕和步态失衡患者越来越多地被送往医院进行静脉溶栓治疗（IVT），这对医疗资源消耗的影响日益增加。本研究旨在探讨在院前环境中，将无其他神经症状的急性眩晕伴失衡患者视为IVT潜在候选者的医学可行性，及其对疗效和临床结局的影响。
方法
回顾性纳入单一中心由救护人员确定为因孤立性眩晕而接受IVT治疗的患者。根据出院诊断对患者进行分类。记录基线特征。采用改良Rankin量表（mRS）评估临床结局。
结果
共纳入163例连续患者。在该队列中，5.5%被诊断为中风，7.9%为疑似中风。在（疑似）中风患者中，59.1%接受了IVT。在（疑似）前庭性眩晕患者中，5.1%接受了IVT。（疑似）中风患者的美国国立卫生研究院卒中量表得分更高[NIHSS；中位数0（四分位数间距1为0；四分位数间距3为1），中位数2（四分位数间距1为0；四分位数间距3为2.5）]。此外，前庭疾病患者和中风患者的行走能力无显著差异。3个月后的mRS评分在各组之间无显著差异。
结论
在超急性期准确区分眩晕的中枢性和外周性病因具有挑战性，存在转诊过度和治疗过度的风险。鉴于缺乏证据表明IVT能改善孤立性眩晕和失衡患者的临床结局，且医疗需求不断增加，作者建议不要立即将这些患者转诊进行IVT，而是考虑对现场救护人员进行充分培训以及采用其他医疗评估和治疗途径。
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