Prehospital delay and emergency department management of ischemic stroke patients in Taiwan, R.O.C.
Prehospital delay and emergency department management of ischemic stroke patients in Taiwan, R.O.C.
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DOI：
10.1080/10903129908958936
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发表时间：
1999-07-01
期刊：
影响因子：
--
通讯作者：
Chang, H
中科院分区：
文献类型：
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作者：
Lin, C S;Tsai, J;Chang, H
目的：确定缺血性卒中患者院前延误的程度以及急诊室 (ED) 就诊与 ED 临床检查之间的时间间隔。与院前延误相关的因素也与人口特征和临床变量相关。方法：1997年10月至1998年4月在台湾五家社区教学医院同时进行了一项前瞻性观察性研究。包括所有患有急性缺血性中风的患者。每例病例均通过颅脑 CT 扫描确诊。测量的主要结果是症状出现两小时以上（T（院前）> 2 小时）到急诊室就诊的患者人数，以及在急诊室进行急诊医生评估、颅脑 CT 扫描、实验室检查和神经科会诊的时间。卡方检验用于比较 T(院前) > 2 小时和 T(院前) < 或 = 2 小时患者的特征。使用多元逻辑回归确定 T（院前）> 2 小时的独立预测因子。 结果：在观察的 157 名患者中，105 名 (67%) 患者在症状出现后超过 2 小时到达医院。从 ED 就诊到 ED 医生检查、完成 CT 扫描和实验室检查的平均时间分别为 3 分钟、58 分钟和 61 分钟。 38 名患者从 ED 就诊到神经科会诊的平均时间为 174 分钟 [24%, (38/157)]。与 T（院前）> 2 小时相关的因素是院间转运（p < 0.05）。 结论：这项研究表明，中风患者的延迟治疗主要是由于急诊就诊延迟以及难以获得神经科会诊。理想情况下，中风中心可以纳入 EMS 系统，以克服因院间转移和获得神经科咨询困难而造成的延误。
OBJECTIVE: To determine the magnitude of prehospital delay and how much time elapses between emergency department (ED) presentation and ED clinical investigations in ischemic stroke patients. Factors associated with prehospital delay were also correlated with demographic characteristics and clinical variables.METHODS: A prospective, observational study was conducted simultaneously in five community teaching hospitals in Taiwan from October 1997 to April 1998. Included were all patients presenting with acute ischemic stroke. In each case, diagnosis was confirmed by cranial CT scanning. The main outcomes measured were the number of patients presenting at the ED more than two hours after the onset of symptoms (T(prehospital) > 2 hr) and the time spent at the ED for ED physician evaluation, cranial CT scanning, laboratory examinations, and neurologic consultation. Chi-square testing was used to compare the characteristics of patients with T(prehospital) > 2 hr and those with T(prehospital)< or = 2 hr. Independent predictors of T(prehospital) > 2 hr were determined using multiple logistic regression.RESULTS: Of 157 patients observed, 105 (67%) arrived at the hospital more than 2 hr after the onset of symptoms. Average time from ED presentation to examination by ED physician, completion of CT scanning, and laboratory investigations was 3, 58, and 61 minutes, respectively. Mean time from ED presentation to neurologic consultation was 174 minutes for 38 patients [24%, (38/157)]. The factor associated with T(prehospital) > 2 hr was interhospital transfer (p < 0.05).CONCLUSION: This study reveals that delayed management of stroke patients is mainly due to delayed ED presentation and to difficulties in obtaining neurologic consultation. Ideally, a stroke center may be incorporated within the EMS system to overcome delays due to interhospital transfer and to difficulties in obtaining neurologic consultation.