Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System
Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System
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DOI：
10.3174/ajnr.a1441
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发表时间：
2009-04-01
影响因子：
3.5
通讯作者：
Gonzalez, R. G.
中科院分区：
文献类型：
--
作者：
Cipriano, L. E.;Steinberg, M. L.;Gonzalez, R. G.
背景与目的：基于神经影像学的缺血性脑卒中分类系统可预测成本和预后，有助于临床预后和医院资源规划。波士顿急性卒中成像量表（BASIS）是一种基于神经成像的缺血性卒中分类系统，在城市学术医疗中心进行了测试，以确定它是否能够预测卒中患者的成本和临床结果。材料和方法：2000年（230例）和2005年（250例）在急诊科就诊的缺血性脑卒中患者通过BASIS分为严重或轻微脑卒中。比较的结果包括死亡、住院时间、出院处置、影像学和重症监护病房（ICU）资源的使用以及住院总费用。连续变量的比较采用单变量分析，采用Student t检验或Satterthwaite检验调整不等方差。分类变量采用chi(2)检验。多元回归分析将住院总费用（因变量）与中风严重程度（严重与轻微）、性别、年龄、合并症的存在和住院期间死亡相关。采用Logistic回归分析来确定表明出院回家可能性较大的显著预测变量。结果：在这两年中，与轻度卒中患者相比，重度卒中患者的住院时间明显更长，在ICU的时间更长，住院费用更高（所有结果，P < 0.0001）。所有死亡（2000年8例，2005年26例）都发生在严重中风患者中。73%的轻度卒中患者出院回家，而重度卒中患者只有12.2%出院回家（P < 0.0001）；61%的严重中风患者出院后进入康复或专业护理机构。2000年和2005年，重度脑卒中患者的费用分别是轻度脑卒中患者的4.4倍和3.0倍。严重脑卒中患者占所有患者的不到三分之一，但其费用占急性脑卒中住院总费用的60%。结论：BASIS是一种基于神经影像学的脑卒中分类系统，在预测院内资源使用、急性住院费用和预后方面非常有效，预测能力在研究期间保持不变。
BACKGROUND AND PURPOSE: A neuroimaging-based ischemic stroke classification system that predicts costs and outcomes would be useful for clinical prognostication and hospital resource planning. The Boston Acute Stroke Imaging Scale (BASIS), a neuroimaging-based ischemic stroke classification system, was tested to determine whether it was able to predict the costs and clinical outcomes of patients with stroke at an urban academic medical center.MATERIALS AND METHODS: Patients with ischemic stroke who presented in the emergency department in 2000 (230 patients) and 2005 (250 patients) were classified by using BASIS as having either a major or minor stroke. Compared outcomes included death, length of hospitalization, discharge disposition, use of imaging and intensive care unit (ICU) resources, and total in-hospital cost. Continuous variables were compared by univariate analysis by using the Student t test or the Satterthwaite test adjusted for unequal variances. Categoric variables were tested with the chi(2) test. Multiple regression analyses related total hospital cost (dependent variable) to stroke severity (major versus minor), sex, age, presence of comorbidities, and death during hospitalization. Logistic regression analysis was applied to identify the significant predictive variables indicating a greater likelihood of discharge home.RESULTS: In both years, individuals with strokes classified as major had a significantly longer length of stay, spent more days in the ICU, and had a higher cost of hospitalization than patients with minor strokes (all outcomes, P < .0001). All deaths (8 in 2000, 26 in 2005) occurred in patients with major stroke. Whereas 73% of patients with minor stroke were discharged home, only 12.2% of patients with major stroke were discharged home (P < .0001); 61% of patients with major stroke were discharged to a rehabilitation or skilled nursing facility. Patients with major stroke cost 4.4 times and 3.0 times that of patients with minor stroke in 2000 and 2005, respectively. Making up less than one third of all patients, patients with major stroke accounted for 60% of the total in-hospital cost of acute stroke care.CONCLUSIONS: BASIS, a neuroimaging-based stroke classification system, is highly effective at predicting in-hospital resource use, acute-hospitalization cost, and outcome, Predictive ability was maintained across the years Studied.