PDF(Pubmed)
Abstract：
Cerebellar strokes have high morbidity and mortality due to bleeding or edema, leading to increased pressure in the posterior fossa. This retrospective cohort study analyzed three outcomes following a cerebellar stroke: in-hospital mortality, length of hospital stay, and total hospitalization costs. It uses data from the National Inpatient Sample (NIS) and aims to identify the predictors of outcomes in cerebellar stroke patients, including 464,324 patients, 18 years of age and older, hospitalized between 2010 and 2015 in US hospitals with cerebellar strokes. In our study, for every decade age increased beyond 59 years, there was a significant increase in mortality; those aged 80+ years had 5.65 odds of mortality (95% CI: 5.32-6.00; P < 0.0001). Significant differences in patient characteristics were observed between patients who survived to discharge and those who did not, including older age (77.4 vs. 70.3 years; P < 0.0001), female sex (58% vs. 52%; P < 0.0001), and being transferred from another healthcare facility (17% vs. 10%; P < 0.0001). Patients admitted directly rather than through the emergency department were more likely to die (29% vs. 16%; P < 0.0001). The mortality rate was lower for blacks (OR: 0.75; P < 0.0001), Hispanics (OR: 0.91; P = 0.005), and Asians (OR: 0.89; P = 0.03), as compared to the white population, for females in comparison to males, and geographically, in all other areas (Midwest, South, and West) in contrast to the Northeast. Cerebellar stroke incidence and high mortality were seen in the traditional stroke belt. Mortality is also affected by the severity of the disease and increases with the Charlson Comorbidity Index (CCI), All Patient Refined Diagnosis Related Groups (APR-DRG) scores, and indirectly by place of receiving care, length of stay (LOS), cost of stay, type of insurance, and emergency department admissions. LOS increased with age, in males in the Northeast, and was less in whites compared to other races. Trend analysis showed a decrease in LOS and costs from 2010 to 2015. Increased costs were seen in non-whites, males, higher household income based on zip code, being covered under Medicaid, transfers, CCI ≥ 5, and discharges in the western US. Median household income based on the patient\'s zip code was well-balanced between those who lived and those who died (P = 0.091). However, payers were not evenly distributed between the two groups (P < 0.0001 for the overall comparison). A higher proportion of discharges associated with in-hospital mortality were covered under Medicare (70% vs. 65% in the died vs. lived groups, respectively). Fewer discharges were associated with death if they were covered by commercial insurance or paid for out-of-pocket (15% vs. 19% for commercial insurance and 3% vs. 5% for out-of-pocket). In-hospital mortality was associated with a longer length of hospital stay (5.6 days vs. 4.5 days; P < 0.0001) and higher costs ($16,815 vs. $11,859; P < 0.0001). Variables that were significantly associated with lower total costs were older age, having commercial insurance, paying out-of-pocket or other payers, not being admitted through the emergency department, having a lower comorbidity index (CCI = 1-2), and being discharged from a hospital that was small- or medium-sized, located in the Midwest or South, and/or was non-teaching (rural or urban).
摘要：
小脑卒中由于出血或水肿有很高的发病率和死亡率，导致后颅窝压力增加。这项回顾性队列研究分析了小脑卒中后的三个结局：住院死亡率，住院时间,和总住院费用。它使用来自国家住院患者样本（NIS）的数据，旨在确定小脑卒中患者预后的预测因素。包括464324名病人,18岁及以上，2010年至2015年在美国小脑卒中医院住院。在我们的研究中,年龄超过59岁的每十年增加，死亡率显著增加;年龄在80岁以上的人群死亡率为5.65(95%CI:5.32-6.00;P<0.0001).存活出院的患者和未存活出院的患者之间观察到患者特征的显着差异，包括年龄较大（77.4vs.70.3年；P<0.0001），女性(58%vs.52%;P<0.0001),并从另一家医疗机构转移(17%与10%;P<0.0001)。直接入院而不是通过急诊科入院的患者更有可能死亡(29%vs.16%；P<0.0001）。黑人的死亡率较低（OR：0.75；P<0.0001），西班牙裔（OR：0.91；P=0.005），和亚洲人（OR：0.89；P=0.03），与白人相比，与男性相比，女性，在地理上，在所有其他地区(中西部，南,和西部）与东北形成鲜明对比。小脑卒中的发病率和高死亡率见于传统卒中带。死亡率也受到疾病严重程度的影响，并随着Charlson合并症指数（CCI）的增加而增加，所有患者精细诊断相关组（APR-DRG）评分，间接地通过接受护理的地方，停留时间(LOS)住宿成本,保险类型,和急诊科入院。LOS随着年龄的增长而增加，在东北的男性中，和其他种族相比，白人更少。趋势分析表明，从2010年到2015年，LOS和成本都有所下降。非白人的成本增加，男性,基于邮政编码的更高的家庭收入，被医疗补助覆盖，转账,CCI≥5，并在美国西部出院。基于患者邮政编码的家庭收入中位数在生活者和死亡者之间平衡良好（P=0.091）。然而,支付者在两组间分布不均匀(总体比较P<0.0001).与住院死亡率相关的出院比例更高(70%vs.65%的死者与活着的团体，分别)。如果有商业保险或自付费用，则出院与死亡相关的较少(15%vs.19％的商业保险和3％与5%为自掏腰包）。住院死亡率与住院时间较长相关(5.6天vs.4.5天；P<0.0001）和更高的成本（16,815美元与11,859美元；P<0.0001）。与较低总成本显著相关的变量是年龄较大，有商业保险,自付或其他付款人，没有通过急诊科入院,具有较低的共病指数(CCI=1-2)，从中小型医院出院，位于中西部或南部，和/或非教学（农村或城市）。
