Early Hospital Arrival Improves Outcome at Discharge in Ischemic but Not Hemorrhagic Stroke: A Prospective Multicenter Study
Early Hospital Arrival Improves Outcome at Discharge in Ischemic but Not Hemorrhagic Stroke: A Prospective Multicenter Study
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DOI：
10.1159/000215941
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发表时间：
2009-01-01
影响因子：
2.9
通讯作者：
Minematsu, Kazuo
中科院分区：
文献类型：
--
作者：
Naganuma, Masaki;Toyoda, Kazunori;Minematsu, Kazuo
背景：我们的目的是确定发病至到达时间是否影响卒中患者的预后。研究方法：我们进行了一项前瞻性多中心研究，包括1,817例缺血性卒中患者和1,226例脑出血患者，这些患者在症状发作24小时内到医院就诊。主要结局是独立的日常生活活动能力，对应于改良的兰金量表（mRS）评分= 8小时，p < 0.001）。这些组出院时的中位mRS评分分别为3、2和2（p < 0.001）。在调整基础特征和初始NIHSS评分后，最早组患者出院时的独立日常生活能力是最晚组患者的1.73倍（95% CI = 1.24-2.42，p = 0.001）。在大动脉粥样硬化和心源性卒中的亚组分析中也显示了类似的趋势。在脑出血患者中，初始NIHSS评分和出院时的mRS评分均随着发病至到达时间的增加而降低。经多变量校正后，最早（< 1.2 h）和第二个三分位组（1.2-3.5 h）患者的独立日常生活能力分别比最晚三分位组（>= 3.5 h）患者低2.33倍（p <0.001）和1.69倍（p = 0.006）。结论：早期到达医院可改善缺血性卒中患者的临床结局，但对脑出血患者无效。版权所有（C）2009 S. Karger AG，巴塞尔
Background: Our purpose was to determine whether the onset-to-arrival time affects the outcome of stroke patients. Methods: We carried out a prospective multicenter study involving 1,817 patients with ischemic stroke and 1,226 with intracerebral hemorrhage who presented to hospitals within 24 h of symptom onset. The primary outcome was independent activity of daily living corresponding to a modified Rankin Scale (mRS) score = 8 h, p < 0.001). The median mRS scores at discharge in these groups were 3, 2 and 2, respectively (p < 0.001). After adjustment for underlying features and the initial NIHSS score, the independent activity of daily living at discharge was 1.73 times more common in patients in the earliest group than in the latest group (95% CI = 1.24-2.42, p = 0.001). A similar tendency was shown in the sub-analysis for large-artery atherosclerosis and cardioembolic stroke. In intracerebral hemorrhage patients, both the initial NIHSS score and the mRS score at discharge decreased as the onset-to-arrival time increased. After multivariate adjustment, the independent activity of daily living was 2.33 times (p < 0.001) and 1.69 times (p = 0.006) less common in patients in the earliest (< 1.2 h) and second tertile groups (1.2-3.5 h), respectively, than in the latest tertile group (>= 3.5 h). Conclusions: Early hospital arrival improved the clinical outcome in ischemic stroke patients but not in patients with intracerebral hemorrhage. Copyright (C) 2009 S. Karger AG, Basel