Scott P A, Temovsky C J, Lawrence K, Gudaitis E, Lowell M J
Section of Emergency Medicine, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Mich., and Hoffmann-La Roche, Ltd (Canada), Toronto, Canada.
Stroke. 1998 Nov;29(11):2304-10. doi: 10.1161/01.str.29.11.2304.
We sought to identify the Canadian population with potential access to intravenous tissue plasminogen activator within 3 hours of onset of acute ischemic stroke.
Assuming that 60 minutes is needed for stroke recognition, emergency room evaluation, and administration of tissue plasminogen activator, 120 minutes remain for transport, using a 3-hour treatment window. Ambulance databases were analyzed for transport times of 60, 90, and 120 minutes and were found to correspond to transport distances of 32, 64, and 105 kilometers (20, 40, and 65 miles), respectively. Using Geographical Information System (GIS) software, these radii were overlaid on thematic maps of Canadian hospitals identified as having a third- or fourth-generation CT and with a neurologist and an emergency physician on staff. Analysis was then performed on complete Canadian census data from 1991 and the interim 1996 census count.
67.3%, 78.2%, and 85.3% of the total Canadian population were within 32, 64, and 105 kilometers, respectively, of an identified hospital. For individuals >/=65 years of age, 64.4%, 77.0%, and 85.7% were within the respective radii. Complete analysis by age, ethnic origin, and gender are detailed.
In the model described, a substantial percentage of the Canadian population has geographic access to a hospital potentially capable of delivering intravenous thrombolysis for acute ischemic stroke. GIS analysis can identify both population groups and rural areas with limited access to thrombolytic stroke treatment. A coordinated emergency medical service response for stroke is advocated to maximize coverage, as a 60-minute delay in emergency room arrival eliminated 5.1 million people from potential treatment.
我们试图确定在急性缺血性卒中发病3小时内有可能接受静脉注射组织型纤溶酶原激活剂（tPA）治疗的加拿大人群。
假设卒中识别、急诊室评估及给予组织型纤溶酶原激活剂需要60分钟，那么在3小时的治疗时间窗内，还剩120分钟用于转运。对救护车数据库进行分析，得出转运时间为60分钟、90分钟和120分钟时分别对应的转运距离为32公里（20英里）、64公里（40英里）和105公里（65英里）。利用地理信息系统（GIS）软件，将这些半径覆盖在已确定的拥有第三代或第四代CT且配备神经科医生和急诊医生的加拿大医院的专题地图上。然后对1991年加拿大完整人口普查数据以及1996年中期人口普查临时数据进行分析。
分别有67.3%、78.2%和85.3%的加拿大总人口居住在距已确定医院32公里、64公里和105公里范围内。对于年龄大于或等于65岁的个体，相应半径范围内的比例分别为64.4%、77.0%和85.7%。按年龄、种族和性别进行的完整分析详情如下。
在所描述的模型中，相当比例的加拿大人口在地理上能够前往有可能提供急性缺血性卒中静脉溶栓治疗的医院。GIS分析可以识别出获得溶栓性卒中治疗机会有限的人群和农村地区。提倡针对卒中采取协调一致的紧急医疗服务应对措施，以最大限度地扩大覆盖范围，因为急诊室到达时间延迟60分钟会使510万人失去接受潜在治疗的机会。
