Late night activity regarding stroke codes: LuNAR strokes.
Late night activity regarding stroke codes: LuNAR strokes.
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有关中风代码的深夜活动：LuNAR 中风。
DOI：
10.1111/j.1747-4949.2011.00610.x
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Meyer,BrettC
中科院分区：
文献类型：
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作者：
Tafreshi,Gilda;Raman,Rema;Ernstrom,Karin;Rapp,Karen;Meyer,BrettC
背景：心脏骤停和心源性猝死的日变化。中风可能表现出类似的模式。我们评估了在白天或晚上的特定时间出现中风是否更有可能是血管病因。目的比较急诊部门在22:00至8:00之间到达的中风代码（月相中风）与其他（n-月相中风）。目的是确定深夜中风是否更有可能是真正的中风，还是需要进行急性组织纤溶酶原激活剂评估。方法：我们前瞻性地回顾了加州大学圣地亚哥分校中风小组数据库中收集的四年期间的病例。根据到达时间对六个急诊科的中风代码进行分类。22:00至8:00之间到达的人被归类为月球中风代码，其余的被归类为“n-LuNAR”。将患者进一步分为脑出血、急性缺血性脑卒中未使用组织型纤溶酶原激活剂、急性缺血性脑卒中使用组织型纤溶酶原激活剂、短暂性脑缺血发作和非脑卒中。分类结果采用Fisher’s Exact检验进行比较。使用Wilcoxon's Rank-sum检验比较连续结果。结果共纳入1607例患者，其中299例（19%）为LuNAR code卒中。总体NIHSS中位数为5，LuNAR组更高（n-LuNAR 5, LuNAR 7；P= 0.022）。LuNAR与n-LuNAR卒中患者的诊断差异无统计学意义（P= 0.169），接受组织型纤溶酶原激活剂(n-LuNAR 191 （14.6%), LuNAR 42(14.0%)）的急性缺血性卒中患者的诊断差异无统计学意义；P = 0.86)。平均到达计算机断层扫描时间在LuNAR hour更长（n-LuNAR 54.9±76.3 min, LuNAR 62.5±87.7 min；P= 0.027）。两组90天死亡率无显著差异（n-LuNAR 15.0%, LuNAR 13.2%；P= 0.45）。结论脑卒中中心经验对急性缺血性脑卒中的诊断无昼夜差异。这种相似性在组织纤溶酶原激活剂施用的相似率中得到进一步支持。由于从症状发作到计算机断层扫描的时间较长，深夜中风可能需要更快速的中风专家评估。
BackgroundThere is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology.AimTo compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations.MethodsWe reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as ‘n-LuNAR’. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and non-stroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test.ResultsA total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7;P= 0.022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P= 0.169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14.6%), LuNAR 42 (14.0%);P= 0.86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54.9±76.3 min, LuNAR 62.5±87.7 min;P= 0.027). There was no significant difference in 90-day mortality (n-LuNAR 15.0%, LuNAR 13.2%;P= 0.45).ConclusionsOur stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This similarity was further supported in similar rates of tissue plasminogen activator administration. Late night strokes may warrant a more rapid stroke specialist evaluation due to the longer time elapsed from symptom onset and the longer time to computed tomography scan.