流动卒中单元对符合静脉溶栓条件的急性缺血性卒中患者的管理。

IF 20.4 1区 医学 Q1 CLINICAL NEUROLOGY
Brian Mac Grory, Jie-Lena Sun, Brooke Alhanti, Jay Lusk, Fan Li, Opeolu Adeoye, Karen Furie, David Hasan, Steven Messe, Kevin N Sheth, Lee H Schwamm, Eric E Smith, Deepak L Bhatt, Gregg C Fonarow, Jeffrey L Saver, Ying Xian, James Grotta
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引用次数: 0

摘要

重要性:临床试验表明,移动卒中单元(MSU)的院前管理可改善可能符合静脉溶栓条件的急性缺血性卒中患者的功能预后,但常规临床实践中有关这一主题的实际证据却很少:目的:确定 MSU 院前管理与标准急救医疗服务(EMS)管理之间的关系,以及出院时的全身残疾程度:这是一项回顾性、观察性、队列研究,纳入了最终诊断为缺血性卒中的连续患者,他们在 2018 年 8 月 1 日至 2023 年 1 月 31 日期间接受了 MSU 院前管理或标准 EMS 管理。随访至出院时结束。主要分析队列包括可能符合静脉溶栓条件的患者。另外还分析了一个独立的重叠队列,包括所有患者,无论其诊断结果如何。患者数据来自美国心脏协会的Get With The Guidelines-Stroke(GWTG-Stroke)计划,这是一项全国性的多中心质量保证登记计划。该分析于2024年5月完成:主要结果和测量指标:主要疗效终点是实用加权改良Rankin量表(UW-mRS)评分。次要疗效终点是独立行走状态。主要安全性终点是症状性颅内出血(sICH)和院内死亡率:在106家医院接受治疗的19 433名患者(中位数[IQR]年龄为73[62-83]岁;9867名女性[50.8%])中,有1237名患者(6.4%)在MSU接受了院前治疗。在MSU接受院前治疗与出院时UW-mRS评分较高(调整后平均差异为0.03;95% CI为0.01-0.05)和出院时独立行走的可能性较高(53.3% [878名患者中的468名] vs 48.3% [12148名患者中的5868名];调整后风险比[aRR]为1.08;95% CI为1.03-1.13)有关。两组患者的 sICH(5.2% [1094例中的57例] vs 4.2% [13014例中的545例];aRR,1.30;95% CI,0.94-1.75])或院内死亡率(5.7% [1237例中的70例] vs 6.2% [18196例中的1121例];aRR,1.03;95% CI,0.78-1.27)无明显统计学差异:在可能符合静脉溶栓条件的急性缺血性脑卒中患者中,与标准急救医疗服务相比,MSU 的院前管理与出院时总体残疾程度显著降低有关。这些发现支持扩大院前 MSU 管理的政策努力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mobile Stroke Unit Management in Patients With Acute Ischemic Stroke Eligible for Intravenous Thrombolysis.

Importance: Clinical trials have suggested that prehospital management in a mobile stroke unit (MSU) improves functional outcomes in patients with acute ischemic stroke who are potentially eligible for intravenous thrombolysis, but there is a paucity of real-world evidence from routine clinical practice on this topic.

Objective: To determine the association between prehospital management in an MSU vs standard emergency medical services (EMS) management and the level of global disability at hospital discharge.

Design, setting, and participants: This was a retrospective, observational, cohort study that included consecutive patients with a final diagnosis of ischemic stroke who received either prehospital management in an MSU or standard EMS management between August 1, 2018, and January 31, 2023. Follow-up ended at hospital discharge. The primary analytic cohort included those who were potentially eligible for IV thrombolysis. A separate, overlapping cohort including all patients regardless of diagnosis was also analyzed. Patient data were obtained from the American Heart Association's Get With The Guidelines-Stroke (GWTG-Stroke) Program, a nationwide, multicenter quality assurance registry. This analysis was completed in May 2024.

Exposure: Prehospital management in an MSU (vs standard EMS management).

Main outcomes and measures: The primary efficacy end point was the utility-weighted modified Rankin Scale (UW-mRS) score. The secondary efficacy end point was independent ambulation status. The coprimary safety end points were symptomatic intracranial hemorrhage (sICH) and in-hospital mortality.

Results: Of 19 433 patients (median [IQR] age, 73 [62-83] years; 9867 female [50.8%]) treated at 106 hospitals, 1237 (6.4%) received prehospital management in an MSU. Prehospital management in an MSU was associated with a better score on the UW-mRS at discharge (adjusted mean difference, 0.03; 95% CI, 0.01-0.05) and a higher likelihood of independent ambulation at discharge (53.3% [468 of 878 patients] vs 48.3% [5868 of 12 148 patients]; adjusted risk ratio [aRR], 1.08; 95% CI, 1.03-1.13). There was no statistically significant difference in sICH (5.2% [57 of 1094] vs 4.2% [545 of 13 014]; aRR, 1.30; 95% CI, 0.94-1.75]) or in-hospital mortality (5.7% [70 of 1237] vs 6.2% [1121 of 18 196]; aRR, 1.03; 95% CI, 0.78-1.27) between the 2 groups.

Conclusions and relevance: Among patients with acute ischemic stroke potentially eligible for intravenous thrombolysis, prehospital management in an MSU compared with standard EMS management was associated with a significantly lower level of global disability at hospital discharge. These findings support policy efforts to expand access to prehospital MSU management.

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来源期刊
JAMA neurology
JAMA neurology CLINICAL NEUROLOGY-
CiteScore
41.90
自引率
1.70%
发文量
250
期刊介绍: JAMA Neurology is an international peer-reviewed journal for physicians caring for people with neurologic disorders and those interested in the structure and function of the normal and diseased nervous system. The Archives of Neurology & Psychiatry began publication in 1919 and, in 1959, became 2 separate journals: Archives of Neurology and Archives of General Psychiatry. In 2013, their names changed to JAMA Neurology and JAMA Psychiatry, respectively. JAMA Neurology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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