A multicentre observational study of presentation and early assessment of acute stroke
A multicentre observational study of presentation and early assessment of acute stroke
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DOI：
10.1136/bmj.325.7354.17
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发表时间：
2002-07-06
影响因子：
105.7
通讯作者：
Kalra, L
中科院分区：
文献类型：
--
作者：
Harraf, F;Sharma, AK;Kalra, L
目的调查疑似卒中患者就诊延迟及评估情况。设计多中心前瞻性观察研究，在英国和都柏林设立22家医院，受试者为739名就诊的疑似卒中患者，主要衡量患者从出现中风症状到入院的时间和从到达医院到高级医生评估的时间。结果患者的中位年龄为75岁，其中女性400人。从出现症状到到达医院的中位延迟时间为6小时(四分位数范围从1小时48分钟到19小时12分钟)。37%的患者在3小时内到达，50%的患者在6小时内到达。使用急救服务的患者的中位延迟时间为2小时3分钟(47分钟至7小时12分钟)，而来自全科医生的转介患者的中位延迟时间为7小时12分钟(2小时5分钟至20小时37分钟)(P<；0.0001)。急救服务的使用减少了到医院的延误(优势比0.45，95%可信区间0.23至0.61)。高级医生评估的中位滴度为1小时9分钟(四分位数范围为33分钟至1面粉50分钟)，但只有477名(65%)患者在到达后3小时内进行了检测。这不受年龄、性别、发病时间、转诊方式、医院类型或卒中单元的存在的影响。166名(22%)患者在到达医院后3小时内要求进行计算机断层扫描，但只有60名(8%)患者进行了计算机断层扫描。结论增加急救服务的使用可以减少疑似中风患者到达医院的延误。超过三分之一的患者在中风后三个小时内到达医院；通过加快医学评估和及早进行计算机断层扫描，他们的管理可以得到改善。
Objective To investigate delays in the presentation to hospital and evaluation of patients with suspected stroke.Design Multicentre prospective observational study.Setting 22 hospitals in the United Kingdom and Dublin.Participants 739 patients with suspected stroke presenting to hospital.Main outcome measures Time from onset of stroke symptoms to arrival at hospital, and time from arrival to evaluation by a senior doctor.Results The median age of patients was 75 years, and 400 were women. The median delay between onset of symptoms and arrival at hospital was 6 hours (interquartile range 1 hour 48 minutes to 19 hours 12 minutes). 37% of patients arrived within 3 hours, 50% within 6 hours. The median delay for patients using the emergency service was 2 hours 3 minutes (47 minutes to 7 hours 12 minutes) compared with 7 hours 12 minutes (2 hours 5 minutes to 20 hours 37 minutes) for referrals from general practitioners (P < 0.0001). Use of emergency services reduced delays to hospital (odds ratio 0.45, 95% confidence interval 0.23 to 0.61). The median titre to evaluation by a senior doctor was 1 hour 9 minutes (interquartile range 33 minutes to 1 flour 50 minutes) but was undertaken in only 477 (65%) patients within 3 hours of arrival. This was not influenced by age, sex, time of presentation, mode of referral, hospital type, or the presence of a stroke unit. Computed tomography was requested within 3 hours of arrival in 166 (22%) patients but undertaken in only 60 (8%).Conclusion Delays in patients arriving at hospital with suspected stroke can be reduced by the increased use of emergency services. Over a third of patients arrive at hospital within three hours of stroke; their management can be improved by expediting medical evaluation and performing computed tomography early.