Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke Findings From the China Stroke Center Alliance
Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke Findings From the China Stroke Center Alliance
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DOI：
10.1161/strokeaha.118.024232
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发表时间：
2019-04-01
期刊：
影响因子：
8.3
通讯作者：
Wang, Yong-Jun
中科院分区：
文献类型：
--
作者：
Gu, Hong-Qiu;Rao, Zhen-Zhen;Wang, Yong-Jun
背景和目的-急诊医疗服务对于缺血性卒中患者的早期治疗至关重要，但中国对急诊医疗服务的利用及其与及时治疗的相关性的数据仍然有限。方法：我们查阅了中国卒中中心联盟2015年6月至2018年6月的数据。采用绝对标准差进行协变量的平衡评价。我们使用带有广义估计方程的多变量Logistic模型来解释医院内聚集，以确定与EMS使用相关的人口学和临床因素，以及评估EMS使用与及时治疗的相关性。结果：在分析的560 447名缺血性中风患者中，仅69 841人(12.5%)通过EMS运输。多变量调整结果表明，年龄较小、教育水平较低、保险覆盖范围较小、收入较低、中风严重程度较低、高血压、糖尿病和周围血管疾病的人使用EMS的可能性较小。然而，心血管疾病史与EMS使用量的增加有关。与自运相比，EMS运输与发病到门时间、门到针时间(如果发出预先通知)、更早到达(调整后的优势比[95%CI]对于发病到门时间为2.07[1.95-2.20])显著相关
Background and Purpose-Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited.Methods-We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates' balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment.Results-Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95-2.20] for onset-to-door time