Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke
Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke
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DOI：
10.1161/circoutcomes.109.921858
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发表时间：
2010-05-01
影响因子：
6.9
通讯作者：
Schwamm, Lee H.
中科院分区：
文献类型：
--
作者：
Fonarow, Gregg C.;Reeves, Mathew J.;Schwamm, Lee H.
背景-中风导致大量的死亡和残疾。为了解决这一负担，制定了指南（GWTG）-卒中，以促进测量、跟踪和改善美国急性卒中和短暂性脑缺血发作（TIA）患者的护理质量和结局。方法和结果-我们分析了前1 000 000例急性缺血性卒中、脑出血、蛛网膜下腔出血和短暂性脑缺血发作（TIA）的住院患者来自1392家参与2003 - 2009年GWTG-卒中项目的医院。患者中53.5%为女性，73.3%为白色，平均年龄为70.1 ± 14.9岁。缺血性卒中601599例（60.2%），脑内出血108671例（10.9%），蛛网膜下腔出血34945例（3.5%），未分类卒中26977例（2.7%），TIA 227788例（22.8%）。性能指标显示，脑血管事件类型之间存在小至中度差异。脑出血和蛛网膜下腔出血患者的住院死亡率最高（25.0%和20.4%），缺血性卒中患者居中（5.5%），TIA患者最低（0.3%）。从2003年到2009年，观察到护理质量随时间的显著改善：全或无测量，44.0%对84.3%（+40.3%，P < 0.0001）。在调整患者和医院变量后，6年内全或无测量的累积调整优势比为9.4（95%置信区间，8.3至10.6，P
Background-Stroke results in substantial death and disability. To address this burden, Get With The Guideline (GWTG)-Stroke was developed to facilitate the measurement, tracking, and improvement in quality of care and outcomes for acute stroke and transient ischemic attack (TIA) patients in the United States.Methods and Results-We analyzed the characteristics, performance measures, and in-hospital outcomes in the first 1 000 000 acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and TIA admissions from 1392 hospitals that participated in the GWTG-Stroke Program 2003 to 2009. Patients were 53.5% women, 73.3% white, and with mean age of 70.1 +/- 14.9 years. There were 601 599 (60.2%) ischemic strokes, 108 671 (10.9%) intracerebral hemorrhages, 34 945 (3.5%) subarachnoid hemorrhages, 26 977 (2.7%) strokes not classified, and 227 788 (22.8%) TIAs. Performance measures showed small to moderate differences by cerebrovascular event type. In-hospital mortality rate was highest among intracerebral hemorrhage (25.0%) and subarachnoid hemorrhage (20.4%), and intermediate in ischemic stroke (5.5%) patients and lowest among TIA patients (0.3%). Significant improvements over time from 2003 to 2009 in quality of care were observed: all-or-none measure, 44.0% versus 84.3% (+40.3%, P < 0.0001). After adjustment for patient and hospital variables, the cumulative adjusted odds ratio for the all-or-none measure over the 6 years was 9.4 (95% confidence interval, 8.3 to 10.6, P