目的:尽管很难定义中风护理的质量,具有中度至重度神经功能缺损的急性缺血性卒中(AIS)患者可能会受益于具有卒中单元的具有血栓切除术能力的医院(TCHs),中风专家,和大量的血管内血栓切除术(EVT)病例。
方法:从2013年至2016年收集的国家审计数据中,确定了在24小时内到达的潜在EVT候选人,其基线美国国立卫生研究院卒中量表评分≥6。医院被分类为TCH(≥15例EVT/y,行程单位,和中风专家),无EVT的初级卒中医院(PSHs-无EVT,0case/y),和PSHs与EVT。使用随机截获多水平逻辑回归分析30天和1年病死率(CFRs)。
结果:在35004例AIS患者中,7954例(22.7%)EVT候选者被纳入本研究。无EVTPSHs的平均30天CFR为16.3%,14.8%的PSHs-with-EVT,和11.0%的TCH。无EVTPSHs的平均1年CFR为37.5%,带EVT的PSHs中的31.3%,和26.2%的TCH。在TCH中,在30天的CFR(比值比[OR],0.92;95%置信区间[CI],0.76至1.12),但在1年的CFR(或,0.84;95%CI,0.73至0.96)。
结论:当在TCH治疗EVT候选者时,1年CFR显著降低。TCH不是仅基于EVT的数量来定义的,而且还基于中风单元和中风专家的存在。这支持了韩国对TCH认证的需求,并表明每年的EVT案例量可用于鉴定TCH。
OBJECTIVE: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT)
case volume.
METHODS: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT
case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0
case/y), and PSHs-with-EVT. Thirty-day and 1-year
case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression.
RESULTS: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96).
CONCLUSIONS: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT
case volume could be used to qualify TCHs.