Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke.
Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke.
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病人害怕回家吗？
DOI：
10.1136/emermed-2019-209154
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Kronish,IanM
中科院分区：
文献类型：
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作者：
Chang,BernardP;Cornelius,Talea;Willey,Joshua;Edmondson,Donald;Elkind,MitchellSv;Kronish,IanM
背景最近的证据表明，通过急诊科出院和快速门诊随访或住院治疗短暂性脑缺血发作和轻微卒中(TIAMS)，临床上是平衡的。了解患者的喜好可能会指导TIAMS后的处置决策，从而提高患者的满意度和依从性。心理困扰，特别是脆弱感(如“威胁感知”)与TIAMS后的不良心理结果相关，并可能影响患者的倾向。我们假设ED中具有较高威胁感的患者更愿意住院而不是早期出院，并获得快速的门诊随访。方法这是对疑似TIAMS的ED患者(定义为美国国立卫生研究院卒中评分≤5)的前瞻性观察队列研究的计划二次分析。结果147例TIAMS患者(平均年龄：59.7±15.4，女性占45.6%，西班牙裔占39.5%，NIHSS中位数=1，IQR：0，3)。与急诊室出院相比，大多数患者(98，66.7%)更喜欢住院治疗。总体威胁得分中值为1.0(IQR：0.43，1.68)。与倾向于早期处置的人(中位数：1.00，IQR：0.43，1.57)相比，倾向于入院的人的威胁得分相似(中位数：1.00，IQR：0.49，1.68；p=0.40)。在根据人口统计学特征调整的模型中，威胁感知仍然与倾向偏好无关。结论总体而言，三分之二的TIAMS患者倾向于住院而不是出院。在ED中，倾向与较高的威胁知觉无关。进一步研究患者倾向偏好的潜在驱动因素可能会为患者讨论提供信息，并优化患者满意度。
BackgroundRecent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, ‘threat perception’) is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up.MethodsThis was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1–4).Results147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference.ConclusionOverall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.