安全网医院缺血性脑卒中的预后。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-09-18 DOI:10.1016/j.jstrokecerebrovasdis.2025.108453

Michelle Zhan BA , Shumei Man MD, PhD

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引用次数: 0

摘要

背景：与同类医院相比，安全网医院经常面临资金限制和资源短缺。我们假设在snh治疗的缺血性脑卒中患者与非snh相比预后较差。方法：采用全国住院患者样本数据库，对2016 - 2019年18岁以上急性缺血性脑卒中住院患者进行回顾性研究。比较在snh和非snh治疗的具有或不具有安全网特征的患者的特征和结果。复合不良结局还包括住院死亡率、急性呼吸衰竭、气管切开术和败血症。结果：我们确定了加权总计1,823,985例患者，其中448,965例在snh治疗，1,375,020例在非snh治疗。在SNHs接受治疗的患者与较高的院内死亡率（调整优势比[aOR] 1.14, 95%置信区间[CI] 1.09-1.19）和综合不良结局（aOR 1.18, 95% CI 1.14-1.21）以及较长的住院时间（5.6±7.7 vs 4.5±5.4天）相关(p)。讨论：在SNHs接受缺血性卒中治疗的患者具有较高的院内死亡率和较高的不良结局风险。这种模式在没有安全网特征的患者中被观察到，而在有安全网特征的患者中没有。这些发现支持资源分配的改变和改善snh缺血性卒中护理的努力。

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Outcomes of ischemic stroke in safety-net hospitals

Background

Safety-net hospitals (SNHs) often face financial limitations and resource shortages compared to their counterparts. We hypothesized that patients with ischemic stroke treated at SNHs would have inferior outcomes compared to non-SNHs.

Methods

This retrospective study used the National Inpatient Sample Database to study patients who were ≥18 years old and hospitalized for acute ischemic stroke from 2016 to 2019. The characteristics and outcomes of the patients with or without safety-net features treated at SNHs vs non-SNHs were compared. A composite adverse outcome was also generated to include in-hospital mortality, acute respiratory failure, tracheostomy, and sepsis.

Results

We identified a weighted total of 1,823,985 patients, including 448,965 treated at SNHs and 1,375,020 at non-SNHs. The patients treated at SNHs were associated with higher in-hospital mortality (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.09-1.19) and composite adverse outcome (aOR 1.18, 95% CI 1.14-1.21), and longer hospital length of stay (5.6±7.7 vs 4.5±5.4 days, p<0.001). Patients without safety-net features who were cared for at SNHs had higher in-hospital mortality (aOR 1.14, 95% CI 1.09-1.19), and composite adverse outcomes (aOR 1.19, 95% CI 1.15-1.23) compared to those treated at non-SNHs.

Discussion

Patients treated for ischemic stroke at SNHs have higher in-hospital mortality and an increased risk for adverse outcomes. Such a pattern was observed for patients without safety-net features but not patients with safety-net features. These findings support changes in resource allocation and efforts to improve the care of ischemic stroke in SNHs.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.