Increase in national intravenous thrombolysis rates for ischaemic stroke between 2005 and 2012: is bigger better?
Increase in national intravenous thrombolysis rates for ischaemic stroke between 2005 and 2012: is bigger better?
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DOI：
10.1186/s12883-016-0574-7
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发表时间：
2016-04-21
期刊：
影响因子：
2.6
通讯作者：
Lingsma H
中科院分区：
文献类型：
--
作者：
Scherf S;Limburg M;Wimmers R;Middelkoop I;Lingsma H
缺血性卒中后静脉溶栓治疗显著降低死亡率和发病率。在许多西方国家，实际的溶栓率低得令人难以置信。有研究表明，较高的患者量与较短的上门穿刺时间（DNT）和较高的溶栓率有关。我们解决了一个双重的研究问题：a）2005-2012年荷兰全国溶栓率和上门到针时间的趋势是什么？和B）每家医院的卒中患者数量、溶栓率和DNT之间是否存在关系？我们使用的数据来自Stroke Knowledge Network Netherlands数据集。2005年1月至2012年12月期间，通过对多达65家医院的年度调查，获得了每家医院的容量、静脉溶栓率和入院特征信息。我们使用线性回归来确定住院卒中量、住院溶栓率和平均住院DNT之间的可能关系，并根据患者特征进行调整。可获得121，887例中风入院的信息，从2005年的7，393例入院到2012年的24，067例入院。全国平均溶栓率从2005年的6.4%上升到2012年的14.6%。患者特征（平均年龄、性别、卒中类型）保持稳定。平均DNT从2005年的72.7分钟下降到2012年的41.4分钟。卒中入院量不是平均溶栓率和平均DNT的独立预测因子。2005年至2012年间，荷兰的静脉溶栓率增加了一倍多，与此同时，平均DNT大幅下降。我们没有发现令人信服的证据表明每家医院的卒中患者数量与溶栓率或DNT之间存在关系。
Intravenous thrombolytic therapy after ischaemic stroke significantly reduces mortality and morbidity. Actual thrombolysis rates are disappointingly low in many western countries. It has been suggested that higher patient volume is related to shorter door-to-needle-time (DNT) and increased thrombolysis rates. We address a twofold research question: a) What are trends in national thrombolysis rates and door-to-needle times in the Netherlands between 2005–2012? and b) Is there a relationship between stroke patient volume per hospital, thrombolysis rates and DNT? We used data from the Stroke Knowledge Network Netherlands dataset. Information on volume, intravenous thrombolysis rates, and admission characteristics per hospital is acquired through yearly surveys, in up to 65 hospitals between January 2005 and December 2012. We used linear regression to determine a possible relationship between hospital stroke admission volume, hospital thrombolysis rates and mean hospital DNT, adjusted for patient characteristics. Information on 121.887 stroke admissions was available, ranging from 7.393 admissions in 2005 to 24.067 admissions in 2012. Mean national thrombolysis rate increased from 6.4 % in 2005 to 14.6 % in 2012. Patient characteristics (mean age, gender, type of stroke) remained stable. Mean DNT decreased from 72.7 min in 2005 to 41.4 min in 2012. Volume of stroke admissions was not an independent predictor for mean thrombolysis rate nor for mean DNT. Intravenous thrombolysis rates in the Netherlands more than doubled between 2005 and 2012, in parallel with a large decline in mean DNT. We found no convincing evidence for a relationship between stroke patient volume per hospital and thrombolysis rate or DNT.