Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA -: A prospective, multicenter study
Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA -: A prospective, multicenter study
复制标题
DOI：
10.1161/01.str.30.1.40
复制
发表时间：
1999-01-01
期刊：
影响因子：
8.3
通讯作者：
Peltonen, M
中科院分区：
文献类型：
--
作者：
Wester, P;Rådberg, J;Peltonen, M
背景和目的--早期入院，随后以最小的延迟进行正确的诊断，是急性卒中成功干预的先决条件。本研究的目的是在详细澄清这些delays. Methods相关的因素，这是一个前瞻性的，多中心的，连续的研究，探讨影响因素的时间从中风或短暂性脑缺血发作（TIA）发作，直到病人到达急诊科，中风单位，CT实验室。在入院后3天内，通过使用标准化结构化方案对患者和/或其亲属进行访谈，并评估患者的神经功能缺损。没有关于这项研究的信息是给公众或staff.Results-Patients（n = 329）进行了研究，在15瑞典学术或社区为基础的医院：252例脑梗死，是脑出血，和59 TIA。在卒中和TIA患者中，从发病到入院、卒中单元和CT扫描实验室的中位时间分别为4.8和4.0小时、8.8和7.5小时以及22.0和17.5小时。从多变量方差分析中，以增加住院延迟的数学转换时间作为因变量，获得了显著风险因素的概况。这包括患有脑梗死、逐渐发作、轻度神经系统症状的患者、症状发生时独自一人且未与任何人接触的患者、居住在大型集水区的患者、不使用救护车运输的患者以及访问初级护理站点的患者。这些因素解释了延迟入院的45.3%的方差。卒中组和TLA组从到达急诊室到到达卒中单元或CT扫描实验室（以先发生者为准）的中位时间分别为2.6和2.7小时。较大的集水区、中度至轻度的神经功能障碍以及在急诊室等待医生都与住院延误显着相关。结论-提高公众对中风发作后立即寻求医疗或其他关注的必要性的认识，使用救护车直接运送到急性护理医院，并且需要更有效的院内组织，以便为中风患者提供有效的急性治疗选择。
Background and Purpose-Early admission to hospital followed by correct diagnosis with minimum delay is a prerequisite for successful intervention in acute stroke. This study aimed at clarifying in detail the factors related to these delays.Methods-This was a prospective, multicenter, consecutive study that explored factors influencing the time from stroke or transient ischemic attack (TIA) onset until patient arrival at the emergency department, stroke unit, and CT laboratory. Within 3 days of hospital admission, the patients and/or their relatives were interviewed by use of a standardized structured protocol, and the patients' neurological deficits were assessed. No information about this study was given to the public or to the staff.Results-Patients (n = 329) were studied at 15 Swedish academic or community-based hospitals: 252 subjects with brain infarct, Is with intracerebral hemorrhage, and 59 with TIA. Among stroke and TIA patients, the median times from onset to hospital admission, stroke unit, and CT scan laboratory were 4.8 and 4.0 hours, 8.8 and 7.5 hours, and 22.0 and 17.5 hours, respectively. From multivariate ANOVA with logarithmically transformed time for increasing delay to hospital admission as the dependent variable, a profile of significant risk factors was obtained. This included patients with a brain infarct, gradual onset, mild neurological symptoms, patients who were alone and did not contact anybody when symptoms occurred, patients who lived in a large catchment area, those who did not use ambulance transportation, and those who visited a primary care site. These factors explained 45.3% of the variance in delayed hospital admission. The median time from arrival at the emergency department to arrival at the stroke unit or CT scan laboratory (whichever occurred first) was 2.6 and 2.7 hours in the stroke and TLA groups, respectively. A large catchment area, moderate to mild neurological deficit, and waiting for the physician at the emergency department were all significantly related to in-hospital delay.Conclusions-Increased public awareness of the need to seek medical or other attention promptly after stroke onset, to use an ambulance with direct transportation to the acute-care hospital, and to have more effective in-hospital organization will be required for effective acute treatment options to be available to stroke patients.