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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >The rate of hemicraniectomy for acute ischemic stroke is increasing in the United States.
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The rate of hemicraniectomy for acute ischemic stroke is increasing in the United States.

机译：在美国，急性缺血性脑卒中的半颅切除术的比率正在增加。

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摘要

Recent randomized trials have shown a significant survival and functional outcome benefit with hemicraniectomy compared with medical therapy for carefully selected patients with acute ischemic stroke (AIS). Using a national hospital database, we sought to determine trends over time in rates of hemicraniectomy after AIS before and after publication of the pooled analysis of hemicraniectomy trials demonstrating the benefit of this approach. We queried the Premier database for all stroke-related admissions (denominator) using Diagnosis-Related Group codes 14, 15, and 524 and International Classification of Disease 9 codes 433, 434, and 436, and for hemicraniectomy (numerator) with Current Procedural Terminology codes 01.2, 01.24, 01.25, and 01.39 for fiscal years 2005-2008. Change over time was tested using negative binomial regression. During the study period, a total of 592,933 admissions for AIS were identified. A procedure code for hemicraniectomy was identified in 426 patients (0.072%). These patients tended to be younger, nonwhite, and male; however, 28% of these patients were over age 65. The rate of hemicraniectomy for AIS increased linearly by 21% per year during the study period (P < .001 for trend). After publication of the pooled analysis in the first quarter of 2007, the rate of hemicraniectomy did not increase further (P = .67 for rates before and after). Our data indicate that the rate of hemicraniectomy in AIS patients in the United States has increased over the past few years, but the total number of procedures remains low. Publication of the landmark study did not appear to significantly change this rate. Future studies should investigate the appropriateness of patient selection and missed opportunities for treatment.
机译：最近的随机试验显示，与精心选择的急性缺血性卒中（AIS）患者的药物治疗相比，半颅切除术具有显着的生存率和功能预后获益。使用国家医院数据库，我们试图确定在AIS后半颅切除术的汇总分析的发表前后，随着时间的发展趋势，以证明这种方法的益处。我们使用诊断相关组代码14、15和524和国际疾病分类9代码433、434和436以及所有具有当前程序术语的半颅切除术（分子），查询了Premier数据库中所有与卒中相关的入院（分母）。 2005-2008会计年度的代码01.2、01.24、01.25和01.39。使用负二项式回归测试随时间的变化。在研究期间，总共确定了592,933例AIS入学。在426例患者中确定了半颅切除术的程序代码（0.072％）。这些患者倾向于年轻，非白人和男性。然而，这些患者中有28％的患者年龄在65岁以上。在研究期间，AIS的半颅脑切除术的比例每年线性增加21％（趋势P <.001）。在2007年第一季度发表汇总分析后，半颅脑切除术的比率并未进一步增加（前后比率为P = 0.67）。我们的数据表明，在过去的几年中，美国AIS患者进行半颅切除术的比率有所增加，但手术总数仍然很少。具有里程碑意义的研究的发表似乎并未显着改变这一比率。未来的研究应调查患者选择的适当性和错过的治疗机会。

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