非创伤性脑出血护理的二十年趋势：一项全国性分析

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-05 DOI:10.1016/j.jocn.2025.111300

Andrea Loggini , Faddi G. Saleh Velez , James E. Towner , Jonatan Hornik , Shawn S. Wallery MD , Denise Battaglini , Amber Schwertman , Sarmad Nomani , Alejandro Hornik , Adnan I Qureshi , Victor J. Del Brutto

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引用次数: 0

摘要

目的本研究旨在分析近20年来全国住院患者非外伤性脑出血（ICH）的合并症、并发症和住院死亡率的时间趋势。方法通过全国住院患者样本数据库筛选2002 - 2022年住院的脑出血患者。回顾了社会人口统计学特征、合并症、并发症（包括缺血性中风、癫痫、吸入性肺炎、深静脉血栓形成/肺栓塞DVT/PE）、神经外科手术、气管造口术和经皮胃造口术。分析住院时间和住院死亡率。对每个预定变量使用线性逻辑回归模型确定时间趋势。对于二分类变量，计算自然对数以获得调和线性趋势。采用两两比较进行亚组分析。结果共纳入467117例脑出血患者。从2002年到2022年，合并症显著增加，包括高血压、糖尿病、慢性肾病、肥胖和抗凝血剂的使用。都是0.01。患者年龄随时间逐渐降低(β:-0.104, 95% CI: - 0.124-0.085, p <；0.01)。值得注意的是，缺血性卒中的时间增加(β:0.081, 95% CI: 0.069-0.092, p <；0.01)和癫痫(β:0.012,95% CI: 0.001—-0.008,p & lt;0.01)。随着时间的推移，血块清除/减压下降(β:-0.039, 95% CI: - 0.057-0.022, p <；0.01)，而EVD/VPS放置增加(β:, 95% CI: - 0.057 ~ 0.022, p <；0.01)。住院时间每年增加0.07天(95% CI: 0.04-0.08, p <；0.01)。年平均死亡率每年显著下降2.43%(95%置信区间：- 2.21% - 2.65%,p <；0.01)。与农村地区相比，城市地区的住院死亡率下降得更快(差异0.99%,95% CI: 0.5% - 1.48%, p <；0.01)。性别、种族和收入群体之间没有统计学差异；然而，与高收入群体相比，低收入群体住院死亡率下降的趋势较为缓慢。结论：尽管脑出血患者的复杂性不断增加，但在过去20年里，脑出血患者的住院死亡率稳步下降。这些改善是以更长的住院时间为代价的。农村地区的死亡率仍然存在严重的不平等。

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Two decades of trends in nontraumatic intracerebral hemorrhage care: A nationwide analysis

Purpose

This study aims to analyze the temporal trends of comorbidities, complications, and in-hospital mortality of non-traumatic intracerebral hemorrhages (ICH) over the past two decades using a nationwide inpatient sample.

Methods

The National Inpatient Sample database was screened to identify patients hospitalized with ICH from 2002 to 2022. Socio-demographic characteristics, comorbidities, complications (including ischemic stroke, seizures, aspiration pneumonia, and deep vein thrombosis/pulmonary embolism DVT/PE), neurosurgical procedures, tracheostomy, and percutaneous gastrostomy placement were reviewed. Length of hospital stay and in-hospital mortality were analyzed. Temporal trends were determined using linear logistic regression models for each predetermined variable. For dichotomous variables, the natural logarithm was calculated to achieve a harmonic linear trend. Pairwise comparison was used for subgroup analyses.

Results

A total of 467,117 patients with ICH were included in the study. From 2002 to 2022, there was a significant increase in comorbidities, including hypertension, diabetes, chronic kidney disease, obesity, and anticoagulant use, p < 0.01 for all. Patients’ age progressively decreased over time (β:-0.104, 95 %CI: −0.124–0.085, p < 0.01). Notably, a temporal increase in ischemic stroke (β:0.081, 95 %CI: 0.069–0.092, p < 0.01) and seizures (β:0.012, 95 %CI: 0.001–0.008, p < 0.01) was noted. Clot removal/decompression declined over the years (β:-0.039, 95 %CI: −0.057–0.022, p < 0.01) while EVD/VPS placement increased (β:, 95 %CI: −0.057–0.022, p < 0.01). Length of hospital stay increased yearly by 0.07 days (95 %CI: 0.04–0.08, p < 0.01). The average annual mortality rate significantly decreased by 2.43 % per year (95 %CI: −2.21 %-2.65 %, p < 0.01). In-hospital mortality rates declined more rapidly in urban areas compared to rural areas (0.99 % difference, 95 %CI: 0.5 %-1.48 %, p < 0.01). No statistical difference was observed among sex, racial or income groups; however, there was a trend toward a slower decline in in-hospital mortality among lower-income compared to higher-income groups.

Conclusion

Despite increasing patient complexity, in-hospital mortality has steadily decreased in ICH patients over the last two decades. These improvements have come at the cost of longer hospital stays. Profound inequities remain in the mortality rate in rural areas.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.