Factors Associated with In-Hospital Delay in Intravenous Thrombolysis for Acute Ischemic Stroke: Lessons from China.
Factors Associated with In-Hospital Delay in Intravenous Thrombolysis for Acute Ischemic Stroke: Lessons from China.
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急性缺血性脑卒中住院延迟溶栓治疗的相关因素：中国的经验教训
DOI：
10.1371/journal.pone.0143145
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Wu J
中科院分区：
文献类型：
--
作者：
Huang Q;Ma QF;Feng J;Cheng WY;Jia JP;Song HQ;Chang H;Wu J
住院延误降低了急性缺血性卒中（AIS）静脉溶栓（IVT）治疗的效益，而影响住院延误的因素在中国尚不清楚。我们的目标是通过基于医院的队列确定与院内延误相关的具体因素。住院延误定义为：门到针的时间(DTN)≥60min（标准延误标准）或≥所有DTN的75%（严重延误标准）。人口统计学数据、时间间隔[从发病到上门时间（OTD）、DTN、门到检查时间（DTE）、门到成像时间（DTI）、门到实验室时间（DTL）和最终检测到针头时间（FTN，获得最后一次筛查试验结果的时间与针头时间之间的时间间隔）]、病史和其他变量采用Mann-Whitney U或Pearson卡方检验进行组间比较。并进行多元线性回归分析，确定院内延误的自变量。共纳入202例IVT病例。中位年龄61岁，25.2%为女性。DTN（严重延迟标准）上四分位数的分界点为135min。与无住院延迟的参照组相比，标准延迟组和男性患者年龄较大、OTD较短、转诊较少、出现短暂性脑缺血发作或症状迅速好转、多模型CT显像较多。在多元线性回归分析中，FTN （P<0.001）和DTL （P = 0.002）与标准延迟显著相关；而DTE （P = 0.005）、DTI （P = 0.033）、DTL （P<0.001）和FTN （P<0.001）与严重延迟呈正相关。研究期间DTNs趋势无明显变化（P = 0.054）。在中国，住院延误是由多因素造成的，其中决策过程和实验室检查的时间延误贡献最大。减少延迟的重点应放在筛选试验项目的优化和路径组织的完善上。
In-hospital delay reduces the benefit of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS), while factors affecting in-hospital delay are less well known in Chinese. We are aiming at determining the specific factors associated with in-hospital delay through a hospital based cohort. In-hospital delay was defined as door-to-needle time (DTN) ≥60min (standard delay criteria) or ≥75% percentile of all DTNs (severe delay criteria). Demographic data, time intervals [onset-to-door time (OTD), DTN, door-to-examination time (DTE), door-to-imaging time (DTI), door-to-laboratory time (DTL) and final-test-to-needle time (FTN, the time interval between the time obtaining the result of the last screening test and the needle time)], medical history and additional variables were calculated using Mann-Whitney U or Pearson Chi-Square tests for group comparison, and multivariate linear regression analysis was performed to identify independent variables of in-hospital delay. A total of 202 IVT cases were enrolled. The median age was 61 years and 25.2% were female. The cutoff points for the upper quartile of DTN (severe delay criteria) was 135min.When compared with the reference group without in-hospital delay, older age, shorter OTD and less referral were found in the standard delay group and male sex, presence with transient ischemic attacks or rapidly improving symptom, and with multi-model CT imaging were more frequent in the severe delay group. In the multivariate linear regression analysis, FTN (P<0.001) and DTL (P = 0.002) were significantly associated with standard delay; while DTE (P = 0.005), DTI (P = 0.033), DTL (P<0.001), and FTN (P<0.001) were positively associated with severe delay. There was not a significant change in the trend of DTNs during the study period (P = 0.054). In-hospital delay was due to multifactors in China, in which time delays of decision-making process and laboratory tests contributed the most. Efforts aiming at reducing the delay should be focused on the optimization for the items of screening tests and improvement of the pathway organization.