Ghali J K, Cooper R S, Kowatly I, Liao Y
Division of Cardiology, Cook County Hospital, Chicago, Illinois.
J Natl Med Assoc. 1993 Mar;85(3):180-4.
Prehospital delay is an important cause of out-of-hospital coronary mortality. To determine the effects of decision time delay in a patient population comprised mainly of blacks and the underprivileged, 74 consecutive patients with acute chest pain necessitating admission to the coronary care unit in a large urban hospital were studied. Delay time from onset of chest pain to the decision to seek medical care was markedly prolonged in patients with myocardial infarction (n = 24; mean time: 11.3 +/- 18 hours) as well as in patients with chest pain who did not develop myocardial infarction (n = 50; mean time: 20.5 +/- 26 hours). In addition, transfer time from the emergency room to the coronary care unit was likewise unduly long (mean time: 4 +/- 3.8 and 4.1 +/- 6 hours for patients with and without myocardial infarction, respectively). This study documents a significant delay in the decision time among patients with low socioeconomic status, mostly inner-city blacks, and in the transfer time from emergency room to the critical care unit in a large public hospital. These findings must be taken into consideration when planning strategies to improve the health-care delivery system to blacks and the underprivileged and further lend support to the practice of initiating thrombolytic therapy in the emergency room.
院前延误是院外冠心病死亡的一个重要原因。为了确定决策时间延误在主要由黑人和弱势群体组成的患者群体中的影响，我们对一家大型城市医院中74例因急性胸痛需入住冠心病监护病房的连续患者进行了研究。心肌梗死患者（n = 24；平均时间：11.3 +/- 18小时）以及未发生心肌梗死的胸痛患者（n = 50；平均时间：20.5 +/- 26小时）从胸痛发作到决定寻求医疗救治的延误时间明显延长。此外，从急诊室转至冠心病监护病房的时间同样过长（心肌梗死患者和未发生心肌梗死患者的平均时间分别为4 +/- 3.8小时和4.1 +/- 6小时）。本研究证明，在社会经济地位较低的患者（主要是市中心的黑人）中，决策时间存在显著延误，在一家大型公立医院中，从急诊室转至重症监护病房的时间也存在显著延误。在制定改善针对黑人和弱势群体的医疗保健服务体系的策略时，必须考虑这些发现，这也进一步支持了在急诊室启动溶栓治疗的做法。
