Diagnosis and rehabilitation of visual field defects in stroke patients: a retrospective audit.
Diagnosis and rehabilitation of visual field defects in stroke patients: a retrospective audit.
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DOI：
10.1159/000337016
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发表时间：
2012-01
影响因子：
1.9
通讯作者：
Hoff JM
中科院分区：
文献类型：
--
作者：
Sand KM;Thomassen L;Næss H;Rødahl E;Hoff JM
脑卒中后视野缺损（VFD）可导致严重残疾和生活质量下降。适当的诊断和转介视力康复是重要的，以改善结果。我们的目的是进行一项回顾性临床审计，以调查神经科医生如何检测和跟进VFD中风患者在挪威的一所大学医院。2006年2月至2009年5月期间在卑尔根NORSTROKE登记研究中登记的所有（1）枕叶梗死和（2）非枕叶梗死和临床检测到VFD的患者均纳入本研究。他们的医疗记录进行了审查转介视野检查VFD和转介到视觉康复计划在脑损伤后的第一年。353例患者中，34例（9.6%）接受视野检查，8例（2.3%）接受视力康复。接受视野检查的患者年龄较小（65.1 vs. 74.7岁，p < 0.001），改良兰金量表评分较低（2.53 vs. 3.47，p = 0.003），入院时美国国立卫生研究院卒中量表评分较低（6.68 vs. 13.90，p < 0.001）。男性比女性更常进行视野检查（73.5% vs. 26.5%，p < 0.001），并且这些患者更年轻（61.2% vs. 75.8岁，p = 0.03）。只有少数患者被称为视野检查，甚至更少的提供视力康复。年龄和性别是转诊的负预测因素。神经科医师对VFD相关的重大残疾的认识必须提高。在卒中单元服务中，视力障碍的重点诊断和视力康复计划的早期转诊应是强制性的。
Visual field defects (VFD) after stroke can cause significant disability and reduction in quality of life. Adequate diagnosis of VFD and referral to visual rehabilitation are important to improve outcome. Our aim was to conduct a retrospective clinical audit to investigate how neurologists detect and follow up VFD in stroke patients in a university hospital in Norway. All patients registered in the Bergen NORSTROKE Registry from February 2006 to May 2009 with (1) occipital lobe infarctions and (2) non-occipital infarction and clinically detected VFD were included in the study. Their medical records were reviewed for referral to perimetry for examination of VFD and for referral to a visual rehabilitation program within the first year after brain injury. Of 353 patients, 34 (9.6%) were referred to perimetry and 8 (2.3%) to visual rehabilitation. Patients referred to perimetry were younger (65.1 vs. 74.7 years, p < 0.001), had lower modified Rankin Scale scores (2.53 vs. 3.47, p = 0.003), and scored lower on the National Institutes of Health Stroke Scale upon admission (6.68 vs. 13.90, p < 0.001). Men were more often referred to perimetry than women (73.5 vs. 26.5%, p < 0.001), and those referred were younger (61.2 vs. 75.8 years, p = 0.03). Only few patients were referred to perimetry, and even fewer were offered visual rehabilitation. Age and gender were negative predictors for referral. Neurologists’ awareness of the significant disability related to VFD must be increased. Focused diagnostics on visual impairment and early referral to a visual rehabilitation program should be mandatory in stroke unit services.
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