{"title":"美国急性缺血性脑卒中患者重症监护模式和结果","authors":"Daniel Santos, Luke Maillie, Mandip S Dhamoon","doi":"10.1161/CIRCOUTCOMES.122.008961","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Up to 20% of acute ischemic stroke (AIS) patients may benefit from intensive care unit (ICU)-level care; however, there are few studies evaluating ICU availability for AIS. We aim to summarize the proportion of elderly AIS patients in the United States who are admitted to an ICU and assess the national availability of ICU-level care in AIS.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using de-identified Medicare inpatient datasets from January 1, 2016 through December 31, 2019 for US individuals aged ≥65 years. We used validated <i>International Classification of Diseases, Tenth Revision</i>, Clinical Modification codes to identify AIS admission and interventions. ICU-level care was identified by revenue center code. AIS patient characteristics and interventions were stratified by receipt of ICU-level care, comparing differences through calculated standardized mean difference score due to large sample sizes.</p><p><strong>Results: </strong>From 2016 through 2019, a total of 952 400 admissions by 850 055 individuals met criteria for hospital admission for AIS with 19.9% involving ICU-level care. Individuals were predominantly >75 years of age (58.5%) and identified as white (80.0%). Hospitals on average admitted 11.4% (SD 14.6) of AIS patients to the ICU, with the median hospital admitting 7.7% of AIS patients to the ICU. The ICU admissions were younger and more likely to receive reperfusion therapy but had more comorbid conditions and neurologic complications. Of the 5084 hospitals included, 1971 (38.8%) reported no ICU-level AIS care. Teaching hospitals (36.9% versus 1.6%, <i>P</i><0.0001) with larger AIS volume (<i>P</i><0.0001) or in larger metropolitan areas (<i>P</i><0.0001) were more likely to have an ICU available.</p><p><strong>Conclusions: </strong>We found evidence of national variation in the availability of ICU-level care for AIS admissions. Since ICUs may provide comprehensive care for the most severe AIS patients, continued effort is needed to examine ICU accessibility and utility among AIS.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":"16 3","pages":"e008961"},"PeriodicalIF":6.9000,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Patterns and Outcomes of Intensive Care on Acute Ischemic Stroke Patients in the US.\",\"authors\":\"Daniel Santos, Luke Maillie, Mandip S Dhamoon\",\"doi\":\"10.1161/CIRCOUTCOMES.122.008961\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Up to 20% of acute ischemic stroke (AIS) patients may benefit from intensive care unit (ICU)-level care; however, there are few studies evaluating ICU availability for AIS. We aim to summarize the proportion of elderly AIS patients in the United States who are admitted to an ICU and assess the national availability of ICU-level care in AIS.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using de-identified Medicare inpatient datasets from January 1, 2016 through December 31, 2019 for US individuals aged ≥65 years. We used validated <i>International Classification of Diseases, Tenth Revision</i>, Clinical Modification codes to identify AIS admission and interventions. ICU-level care was identified by revenue center code. AIS patient characteristics and interventions were stratified by receipt of ICU-level care, comparing differences through calculated standardized mean difference score due to large sample sizes.</p><p><strong>Results: </strong>From 2016 through 2019, a total of 952 400 admissions by 850 055 individuals met criteria for hospital admission for AIS with 19.9% involving ICU-level care. Individuals were predominantly >75 years of age (58.5%) and identified as white (80.0%). Hospitals on average admitted 11.4% (SD 14.6) of AIS patients to the ICU, with the median hospital admitting 7.7% of AIS patients to the ICU. The ICU admissions were younger and more likely to receive reperfusion therapy but had more comorbid conditions and neurologic complications. Of the 5084 hospitals included, 1971 (38.8%) reported no ICU-level AIS care. Teaching hospitals (36.9% versus 1.6%, <i>P</i><0.0001) with larger AIS volume (<i>P</i><0.0001) or in larger metropolitan areas (<i>P</i><0.0001) were more likely to have an ICU available.</p><p><strong>Conclusions: </strong>We found evidence of national variation in the availability of ICU-level care for AIS admissions. Since ICUs may provide comprehensive care for the most severe AIS patients, continued effort is needed to examine ICU accessibility and utility among AIS.</p>\",\"PeriodicalId\":10301,\"journal\":{\"name\":\"Circulation. 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引用次数: 1
摘要
背景:高达20%的急性缺血性卒中(AIS)患者可能受益于重症监护病房(ICU)级别的护理;然而，很少有研究评估ICU对AIS的可用性。我们的目的是总结美国老年AIS患者入住ICU的比例，并评估全国AIS ICU级别护理的可得性。方法:我们使用2016年1月1日至2019年12月31日期间未识别的医疗保险住院患者数据集对年龄≥65岁的美国个体进行了回顾性队列研究。我们使用经过验证的国际疾病分类第十版临床修改代码来识别AIS的入院和干预措施。icu级别的护理由收入中心代码标识。通过接受icu级护理对AIS患者的特征和干预措施进行分层，由于样本量大，通过计算的标准化平均差异评分比较差异。结果:从2016年到2019年，共有952 400例患者入院，850 055例患者符合AIS住院标准，其中19.9%涉及icu级别的护理。个体以75岁以上为主(58.5%)，以白人为主(80.0%)。医院平均将11.4% (SD 14.6)的AIS患者送入ICU，中位数为7.7%的AIS患者送入ICU。ICU入院患者年龄更小，更有可能接受再灌注治疗，但有更多的合并症和神经系统并发症。在纳入的5084家医院中，1971家(38.8%)报告没有icu级别的AIS护理。教学医院(36.9% vs . 1.6%， ppp)结论:我们发现了AIS入院患者在icu级别护理可得性方面存在国家差异的证据。由于ICU可以为最严重的AIS患者提供全面的护理，因此需要继续努力检查ICU在AIS中的可及性和实用性。
Patterns and Outcomes of Intensive Care on Acute Ischemic Stroke Patients in the US.
Background: Up to 20% of acute ischemic stroke (AIS) patients may benefit from intensive care unit (ICU)-level care; however, there are few studies evaluating ICU availability for AIS. We aim to summarize the proportion of elderly AIS patients in the United States who are admitted to an ICU and assess the national availability of ICU-level care in AIS.
Methods: We performed a retrospective cohort study using de-identified Medicare inpatient datasets from January 1, 2016 through December 31, 2019 for US individuals aged ≥65 years. We used validated International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify AIS admission and interventions. ICU-level care was identified by revenue center code. AIS patient characteristics and interventions were stratified by receipt of ICU-level care, comparing differences through calculated standardized mean difference score due to large sample sizes.
Results: From 2016 through 2019, a total of 952 400 admissions by 850 055 individuals met criteria for hospital admission for AIS with 19.9% involving ICU-level care. Individuals were predominantly >75 years of age (58.5%) and identified as white (80.0%). Hospitals on average admitted 11.4% (SD 14.6) of AIS patients to the ICU, with the median hospital admitting 7.7% of AIS patients to the ICU. The ICU admissions were younger and more likely to receive reperfusion therapy but had more comorbid conditions and neurologic complications. Of the 5084 hospitals included, 1971 (38.8%) reported no ICU-level AIS care. Teaching hospitals (36.9% versus 1.6%, P<0.0001) with larger AIS volume (P<0.0001) or in larger metropolitan areas (P<0.0001) were more likely to have an ICU available.
Conclusions: We found evidence of national variation in the availability of ICU-level care for AIS admissions. Since ICUs may provide comprehensive care for the most severe AIS patients, continued effort is needed to examine ICU accessibility and utility among AIS.
期刊介绍：
Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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