目的:特发性颅内高压(IIH)的治疗是复杂的,需要多个专业学科。在实践中,这给医疗保健专业人员和患者带来了相当大的组织和沟通挑战。因此,IIH的跨学科综合门诊诊所(包括神经病学,神经眼科学,神经放射学,神经外科和内分泌学)是以中央协调和一站式概念建立的。这里,目的是评估这一一站式理念对客观临床结局的影响.
方法:在一项回顾性队列研究中,在诊断后6个月视力损害/恶化和头痛改善/自由方面,将一站式综合治疗(IC)(2021年7月1日至2022年12月31日)与接受标准治疗(SC)的参考组(2018年7月1日至2019年12月31日)进行了比较.多元二元逻辑回归模型用于校正混杂因素。
结果:IC组(n=85)和SC组(n=81)的基线特征具有可比性(女性90.6%vs.90.1%;平均年龄33.6vs.32.8岁;中位体重指数31.8vs.33.0;脑脊液开放压力中位数32vs.34cmH2O;诊断时,视力障碍在71.8%vs.69.1%和慢性头痛在55.3%vs.IC的56.8%与SC)。IC与头痛改善(比值比[OR]2.24,95%置信区间[CI]1.52-4.33,p<0.001)和头痛缓解(OR1.75,95%CI1.11-3.09,p=0.031)的可能性更高。关于视力障碍和视力恶化的风险,IC在数值上较好,但无统计学意义(OR0.87,95%CI0.69-1.16,p=0.231,OR0.67,95%CI0.41-1.25,p=0.354)。
结论:IIH的跨学科综合治疗与头痛结局以及潜在的视觉结局相关。
OBJECTIVE: Management of idiopathic intracranial hypertension (IIH) is complex requiring multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges for healthcare professionals and patients. Thus, an interdisciplinary integrated outpatient clinic for IIH (comprising neurology, neuroophthalmology, neuroradiology, neurosurgery and endocrinology) was established with central coordination and a one-stop concept. Here, the aim was to evaluate the effects of this one-stop concept on objective clinical outcome.
METHODS: In a retrospective cohort study, the one-stop era with integrated care (IC) (1 July 2021 to 31 December 2022) was compared to a reference group receiving standard care (SC) (1 July 2018 to 31 December 2019) regarding visual impairment/
worsening and headache improvement/freedom 6 months after diagnosis. Multivariate binary logistic regression models were used to adjust for confounders.
RESULTS: Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female 90.6% vs. 90.1%; mean age 33.6 vs. 32.8 years; median body mass index 31.8 vs. 33.0; median cerebrospinal fluid opening pressure 32 vs. 34 cmH2O; at diagnosis, visual impairment was present in 71.8% vs. 69.1% and chronic headache in 55.3% vs. 56.8% in IC vs. SC). IC was associated with a higher likelihood of achieving both headache improvement (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.52-4.33, p < 0.001) and headache freedom (OR 1.75, 95% CI 1.11-3.09, p = 0.031). Regarding the risk of visual impairment and visual
worsening IC was superior numerically but not statistically significantly (OR 0.87, 95% CI 0.69-1.16, p = 0.231, and OR 0.67, 95% CI 0.41-1.25, p = 0.354).
CONCLUSIONS: Interdisciplinary integrated care of IIH is favourably associated with headache outcomes and potentially also visual outcomes.