Horner R D, Sloane R J, Kahn K L
VA Medical Center, Durham, NC 27705, USA.
Health Serv Res. 1998 Feb;32(6):841-59.
To ascertain whether use of mechanical ventilation on admission to the hospital is a proxy indicator of coma (i.e., very severe stroke) among acute stroke patients.
A secondary analysis of data from a medical record review on a nationally representative sample of 2,824 Medicare patients, ages 65 years or older, who were hospitalized for stroke in 1982-1983 or 1985-1986 in 297 acute care hospitals in 30 areas within five geographically dispersed states.
Use of mechanical ventilation on the first day of hospitalization was significantly associated with level of consciousness on admission: < 2 percent of noncomatose patients versus 17.5 percent of comatose (p < .001). With a high specificity and high likelihood ratio for a positive test, use of mechanical ventilation on the first day of hospitalization ruled-in coma. It was also significantly associated with severity of illness, prognostic indicators (i.e., admission through the emergency room, admission to intensive care, and having a "do-not-resuscitate" order written during the hospital stay), and with in-hospital death. Adjusting for patient demographics, stroke type, comorbidity, and process of care, early initiation of mechanical ventilation remained significantly associated with both coma and in-hospital death.
A stroke patient's use of mechanical ventilation on the first day of hospitalization is a valid proxy indicator of level of consciousness.
确定急性卒中患者入院时使用机械通气是否为昏迷（即非常严重的卒中）的替代指标。
对来自一份病历审查的数据进行二次分析，该审查针对1982 - 1983年或1985 - 1986年在五个地理上分散的州的30个地区的297家急性护理医院住院的2824名年龄在65岁及以上的医疗保险患者进行，这些患者具有全国代表性。
住院第一天使用机械通气与入院时的意识水平显著相关：非昏迷患者中<2%使用，而昏迷患者中为17.5%（p <.001）。住院第一天使用机械通气具有较高的特异性和阳性试验似然比，可确诊昏迷。它还与疾病严重程度、预后指标（即通过急诊入院、入住重症监护病房以及在住院期间下达“不要复苏”医嘱）以及院内死亡显著相关。在调整患者人口统计学、卒中类型、合并症和护理过程后，机械通气的早期启动仍与昏迷和院内死亡显著相关。
卒中患者住院第一天使用机械通气是意识水平的有效替代指标。
