Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities
Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities
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DOI：
10.1136/jnnp.2005.083402
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发表时间：
2006-08-01
影响因子：
11
通讯作者：
Mora, G.
中科院分区：
文献类型：
--
作者：
Chiò, A.;Bottacchi, E.;Mora, G.
目的：评估肌萎缩侧索硬化症（ALS）的结果和医院facility.Methods的使用三级中心的影响：这项研究是基于流行病学的数据，前瞻性的，以人口为基础的登记ALS（皮埃蒙特和瓦莱德奥斯塔肌萎缩侧索硬化症登记，PARALS）。1995年和1996年之间招募的221例患者进行了前瞻性随访的结果和使用医院为基础的service.Results：在所有，97例患者进行了随访的第三ALS中心和124由普通神经科诊所。三级ALS中心随访的患者年龄小4岁，更经常接受经皮内窥镜烹饪和无创正压通气。在三级ALS中心随访的患者中位生存时间要长得多（1080 v775天），即使按年龄、发病部位和诊断时的呼吸功能进行分层。在考克斯多变量分析中，参加三级ALS中心被认为是一个独立的积极预后因素。此外，参加三级ALS中心的患者入院率较低（1.2 v 3.3），并且更频繁地接受计划的干预措施。相反，接受普通神经科门诊随访的患者更常因急性事件入院。此外，住院时间是相当短的患者参加三级ALS中心（5.8比12.4天）。结论：改善生存率被认为是在ALS患者参加三级ALS中心，独立于所有其他已知的预后因素，可能通过更好地实施支持性治疗。此外，由于这些中心，住院率显著降低，从而为ALS患者和整个社区提供了具有成本效益的服务。
Objective: To evaluate the effects of tertiary centres for amyotrophic lateral sclerosis (ALS) on ALS outcome and the use of hospital facilities.Methods: The study was based on the data of an epidemiological, prospective, population-based register on ALS (Piemonte and Valle d'Aosta Register for amyotrophic lateral sclerosis, PARALS). The 221 patients recruited between 1995 and 1996 were prospectively followed up for outcome and use of hospital-based services.Results: In all, 97 patients were followed up by tertiary ALS centres and 124 by general neurological clinics. Patients followed up by tertiary ALS centres were found to be 4 years younger and underwent percutaneous endoscopic gastronomy and non-invasive positive-pressure ventilation more often. Patients followed up by tertiary ALS centres were found to have a considerably longer median survival time (1080 v 775 days), even when stratifying by age, site of onset and respiratory function at diagnosis. In Cox multivariate analysis, attending a tertiary ALS centre was observed to be an independent positive prognostic factor. Moreover, patients attending a tertiary ALS centre were admitted to hospital less often (1.2 v 3.3) and were more frequently admitted for planned interventions. Conversely, patients followed up by general neurological clinics were more frequently admitted for acute events. Also, the hospital stay was considerably shorter for patients attending tertiary ALS centres (5.8 v 12.4 days).Conclusions: Improved survival was seen in patients with ALS attending tertiary ALS centres, independently from all other known prognostic factors, possibly through a better implementation of supportive treatments. Moreover, because of these centres, the hospitalisation rate was markedly reduced, thus offering a cost-effective service to patients with ALS and to the community as a whole.