Comprehensive stroke centers and the 'weekend effect': the SPOTRIAS experience.
Comprehensive stroke centers and the 'weekend effect': the SPOTRIAS experience.
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DOI：
10.1159/000345077
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Meyer BC
中科院分区：
文献类型：
--
作者：
Albright KC;Savitz SI;Raman R;Martin-Schild S;Broderick J;Ernstrom K;Ford A;Khatri R;Kleindorfer D;Liebeskind D;Marshall R;Merino JG;Meyer DM;Rost N;Meyer BC
先前的研究发现，在周末，缺血性中风患者的死亡率更高。我们试图评估在一个大型综合性卒中中心(CSC)队列中，周末入院是否与较差的预后相关。使用8个CSC SPOTRIAS数据库识别在症状出现后6小时内出现的连续缺血性中风患者。接受动脉内治疗或参加非观察性临床试验的患者被排除在外。所有符合纳入标准的患者随后被分为两组：工作日入院或周末入院。周末入场时间定义为周五17：01至周一08：59。其余的被归类为工作日入学。对年龄、NIHSS入院时的卒中严重程度和入院时的血糖进行了多变量Logistic回归调整，以比较周末组和工作日组的结果。从2002-2009年SPOTRIAS联合数据库中筛选了8581名受试者。符合纳入标准的有2090例(24.4%)。T-PA治疗率在工作日组和周末组之间无显著差异(58.5%对60.4%，p=.397)。周末入院对住院死亡率(8.4%比9.9%，p=.056)、LOS(4天比5天，p=.442)、良好的出院倾向(38.0%比42.2%，p=.122)、出院时良好的功能结果(41.6%比43.4%，p=.805)、良好的90天功能结果(54.2%比46.9%，p=.301)或90天的死亡率(18.2%比19.8%)没有显著的独立预测作用在调整年龄、NIHSS和入院血糖时，P=.680)。在这一大群在CSC接受治疗的缺血性中风患者中，我们没有观察到“周末效应”。这可能是由于24/7/365全天候接触中风专家、具有中风经验的护士以及CSCS提供有组织的护理系统所致。这些结果表明，对于周末卒中患者优先送往提供各级再灌注治疗的医院，应重新审查EMS方案。这进一步突出了有组织的中风护理的重要性。
Prior studies found mortality among ischemic stroke patients to be higher on weekends. We sought to evaluate whether weekend admission was associated with worse outcomes in a large comprehensive stroke center (CSC) cohort. Consecutive ischemic stroke patients presenting within 6 hours of symptom onset were identified using the 8 CSC SPOTRIAS database. Patients who received intra-arterial therapy or were enrolled in a non-observational clinical trial were excluded. All patients meeting inclusion criteria were then divided into two groups: weekday admissions or weekend admissions. Weekend admission was defined as Friday 17:01 to Monday 08:59. The remainder were classified weekday admissions. Multivariate logistic regression was used adjusting for age, stroke severity on admission via NIHSS, and admission glucose to compare outcomes in the weekend vs. weekday groups. 8581 subjects from the combined SPOTRIAS database were screened from 2002-2009. 2090 (24.4%) met inclusion criteria. There was no significant difference in t-PA treatment rates between weekday and weekend groups (58.5% vs. 60.4%, p=.397). Weekend admission was not a significant independent predictor of in-hospital mortality (8.4% vs. 9.9%, p=.056), LOS (4 days vs. 5 days, p=.442), favorable discharge disposition (38.0% vs. 42.2%, p=.122), favorable functional outcome at discharge (41.6% vs. 43.4%, p=.805), favorable 90 day functional outcome (54.2% vs. 46.9%, p=.301), or 90 day mortality (18.2% vs. 19.8%, p=.680) when adjusting for age, NIHSS, and admission glucose. In this large cohort of ischemic stroke patients treated at CSC’s, we did not observe the “weekend effect.” This may be due to 24/7/365 access to stroke specialists, nurses with stroke experience, and the organized system for delivering care available at CSCs. These results suggest EMS protocol should be reexamined regarding preferential delivery of weekend stroke victims to hospitals that provide all levels of reperfusion therapy. This further highlights the importance of organized stroke care.
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1.8
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