Factors delaying hospital admission in acute stroke: The Copenhagen stroke study
Factors delaying hospital admission in acute stroke: The Copenhagen stroke study
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DOI：
10.1212/wnl.47.2.383
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发表时间：
1996-08-01
期刊：
影响因子：
9.9
通讯作者：
Olsen, TS
中科院分区：
文献类型：
--
作者：
Jorgensen, HS;Nakayama, H;Olsen, TS
中风的药物治疗依赖于狭窄的治疗时间窗。我们前瞻性分析了人口统计学、医学和病理生理因素对1,197例急性脑卒中患者入院延迟的影响。25%的患者在卒中发作后3 1/2小时内入院，35%在6小时内入院，50%在14小时内入院，68%在24小时内入院。独居（优势比[OR] 1.75，95% CI 1.3至2.3）和退休工作状态（OR 1.61，95% CI 1.01至2.54）延迟入院。因此，一个运作良好的社交网络似乎对早期入学很重要。卒中程度越轻，延迟入院的风险越高（卒中严重程度每降低10分，OR为1.25 [入院时斯堪的纳维亚神经卒中量表评分]，95% CI为1.14 - 1.3）。TIA病史使早期入院的相对机会增加1.64（95%CI 1.06 - 2.54）。其他因素如年龄、性别、糖尿病、高血压、缺血性心脏病、其他合并症、既往卒中史、头痛、失语症、失用症、病感失认症、忽视、意识下降、精神状态（简易精神状态检查）和卒中类型（出血性梗死）对入院时间无独立影响。大多数患者入院明显延迟。这是医疗的一个主要障碍。最严重的中风患者应尽早入院，但也应鼓励症状较轻的患者立即入院。短暂性脑缺血发作病史缩短了入院时间，这一观察结果表明，公众意识和知识的提高可能会减少延误并节省宝贵的时间。
Medical treatment of stroke is dependent on a narrow therapeutic time window. We prospectively analyzed the influence of demographic, medical, and pathophysiologic factors on admission delay in 1,197 unselected, acute stroke patients. Twenty five percent were admitted within 3 1/2 hours, 35% within 6 hours, 50% within 14 hours, and 68% within 24 hours after stroke onset. Living alone (odds ratio [OR] 1.75, 95% CI 1.3 to 2.3) and retired working status (OR 1.61, 95% CI 1.01 to 2.54) delayed admission. A well-working social network thus seems important to early admission. The milder the stroke, the higher was the risk of delayed admission (OR 1.25 per 10 points decrease in stroke severity [Scandinavian Neurological Stroke Scale score on admission], 95% CI 1.14 to 1.3). A history of TIA increased the relative chance of early admission by odds 1.64 (95% CI 1.06 to 2.54). Other factors such as age, sex, diabetes, hypertension, ischemic heart disease, other comorbidity, previous stroke, headache, aphasia, apraxia, anosognosia, neglect, lowered consciousness, mental status (Mini-Mental State Examination) and type of stroke (hemorrhage infarct) had no independent influence on admission time. Admission was markedly delayed in most patients. This represents a major barrier to medical treatment. Patients with the most severe strokes are admitted early, but patients with milder symptoms should also be encouraged to seek immediate admission. The observation that a history of TIA reduced admission time indicates that an increase in public awareness and knowledge may reduce delay and save precious time.