Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals.
Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals.
复制标题
DOI：
10.1371/journal.pone.0029193
复制
发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Coumans JV
中科院分区：
文献类型：
--
作者：
Walcott BP;Kuklina EV;Nahed BV;George MG;Kahle KT;Simard JM;Asaad WF;Coumans JV
随机试验已经证明了颅骨切除术治疗缺血性脑卒中后恶性脑水肿的疗效。我们试图通过使用国家数据库来确定与此相关的患病率和结果。从1999年至2008年美国全国住院患者样本中查询以缺血性卒中为主要诊断行颅骨切除术的出院患者。确定了接受溶栓治疗的患者亚群。研究了两个主要终点：住院死亡率和出院回家/常规护理。为了便于解释，调整后的患病率是根据总体患病率和两个年龄特定的逻辑回归模型计算的。然后使用多变量logistic回归模型生成预测边际，以估计在调整住院类型、住院来源、住院时间、医院总收费、慢性合并症和医疗并发症后住院死亡率的概率。在排除71,996例诊断为颅内出血和颅内后循环闭塞的患者后，我们确定了4,248,955例以缺血性卒中为主要诊断的成人住院患者。因缺血性中风而住院的每10000例患者中，开颅手术的估计住院率从1999-2000年的3.9例增加到2007-2008年的14.46例（线性趋势p <0.001）。60岁以上患者住院死亡率为44%，18-59岁组住院死亡率为24%（p = 0.14）。如果给予重组组织型纤溶酶原激活剂，结果是相似的。颅切除术越来越多地用于大面积脑缺血后的恶性脑水肿。我们怀疑，恶性脑水肿的DC年发病率的增加与随机试验中证据收集的扩大直接相关，这些证据表明，在正确的患者群体中进行手术是有效的。在医院里，所有接受这种手术的病人的死亡率都很高。
Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database. Patient discharges with ischemic stroke as the primary diagnosis undergoing craniectomy were queried from the US Nationwide Inpatient Sample from 1999 to 2008. A subpopulation of patients was identified that underwent thrombolysis. Two primary end points were examined: in-hospital mortality and discharge to home/routine care. To facilitate interpretations, adjusted prevalence was calculated from the overall prevalence and two age-specific logistic regression models. The predictive margin was then generated using a multivariate logistic regression model to estimate the probability of in-hospital mortality after adjustment for admission type, admission source, length of stay, total hospital charges, chronic comorbidities, and medical complications. After excluding 71,996 patients with the diagnosis of intracranial hemorrhage and posterior intracranial circulation occlusion, we identified 4,248,955 adult hospitalizations with ischemic stroke as a primary diagnosis. The estimated rates of hospitalizations in craniectomy per 10,000 hospitalizations with ischemic stroke increased from 3.9 in 1999–2000 to 14.46 in 2007–2008 (p for linear trend<0.001). Patients 60+ years of age had in-hospital mortality of 44% while the 18–59 year old group was found to be 24%(p = 0.14). Outcomes were comparable if recombinant tissue plasminogen activator had been administered. Craniectomy is being increasingly performed for malignant cerebral edema following large territory cerebral ischemia. We suspect that the increase in the annual incidence of DC for malignant cerebral edema is directly related to the expanding collection of evidence in randomized trials that the operation is efficacious when performed in the correct patient population. In hospital mortality is high for all patients undergoing this procedure.
登录
查看更多内容
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
4.8
作者：
KONDZIOLKA, D;FAZL, M
通讯作者：
FAZL, M
影响因子：
5.6
作者：
Palestrant, David;Frontera, Jennifer A;Mayer, Stephan A
通讯作者：
Mayer, Stephan A
影响因子：
8.3
作者：
DELASHAW, JB;BROADDUS, WC;GRADY, MS
通讯作者：
GRADY, MS
DOI：
10.1016/s0750-7658(03)00069-8
发表时间：
2003-04-01
影响因子：
--
作者：
Gasche, Y;Copin, JC
通讯作者：
Copin, JC