Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke
Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke
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DOI：
10.1161/strokeaha.107.510362
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发表时间：
2008-08-01
期刊：
影响因子：
8.3
通讯作者：
Kapral, Moira K.
中科院分区：
文献类型：
--
作者：
Saposnik, Gustavo;Hill, Michael D.;Kapral, Moira K.
背景和目的：7天、30天和1年病死率指标已被用于比较医院、省份和国家之间的卒中护理，并实施质量改进策略。然而，在这些不同的时间点，关于与卒中病例死亡率相关的变量的信息有限。我们试图确定和比较变量与7天，30天，1年中风fatality.Methods -这是一个队列研究的急性缺血性中风患者连续入住11中风中心在加拿大安大略，2003年7月和2005年3月之间，并在加拿大中风网络（RCSN）的注册。将RCSN数据库与管理数据库链接，以采集因缺血性卒中住院后7、30和365天内发生的所有死亡。Logistic回归分析用于确定每个时间点与卒中死亡率相关的变量。结果指标为入院后7天、30天和1年内所有部位的死亡率。结果-我们的队列包括3631例缺血性卒中患者。7天病死率为6.9%（249/3631），30天病死率为12.6%（457/3631），1年病死率为23.6%（856/3631）。在多变量分析中，卒中严重程度、住院期间神经功能恶化、住院期间未使用抗血栓药物以及卒中小组评估不足是卒中后7天、30天和1年病死率最一致的预测因素。医生在卒中管理方面的经验与7天和30天死亡率呈负相关，而年龄、合并症和住院期间的肺炎与30天和1年死亡率相关。结论-卒中严重程度和某些护理过程与卒中后7天、30天和1年的病死率相关。这些信息可能有助于比较医院之间的风险调整后的病死率，并有助于实施改善卒中急性期护理流程和质量的策略。
Background and Purpose - Seven-day, 30-day, and 1-year case-fatality indicators have been used to compare stroke care among hospitals, provinces, and countries and to implement quality improvement strategies. However, limited information is available concerning variables associated with stroke case fatality at these different points in time. We sought to identify and compare variables associated with 7-day, 30-day, and 1-year stroke fatality.Methods - This was a cohort study of consecutive patients with acute ischemic stroke admitted to 11 stroke centers in Ontario, Canada, between July 2003 and March 2005 and captured in the Registry of the Canadian Stroke Network (RCSN). The RCSN database was linked to administrative databases to capture all deaths occurring within 7, 30, and 365 days of hospital admission for ischemic stroke. Logistic regression was used to determine variables associated with stroke fatality at each time point. Outcome measures were all-location mortality within 7 days, 30 days, and 1 year of hospital admission.Results - Our cohort included 3631 patients admitted with ischemic stroke. Seven-day case fatality was 6.9% (249/3631), 30-day case fatality was 12.6% (457/3631), and 1-year case fatality was 23.6% (856/3631). In the multivariable analyses, stroke severity, neurologic deterioration during hospitalization, nonuse of antithrombotics during hospital admission, and lack of assessment by a stroke team were the most consistent predictors of case fatality at 7 days, 30 days, and 1 year after stroke. Physician experience in stroke management was inversely associated with 7-day and 30-day mortality, whereas age, comorbid illness, and pneumonia during hospital admission were associated with 30-day and 1-year mortality.Conclusions - Stroke severity and certain processes of care were associated with case fatality at 7days, 30 days, and 1 year after stroke. This information may be useful for comparing risk-adjusted case-fatality rates among hospitals and for implementing strategies to improve the processes and quality of care in the acute phase of stroke.