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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >'code stroke': Hospitalized versus emergency department patients
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'code stroke': Hospitalized versus emergency department patients

机译：“中风”：住院患者与急诊科患者

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摘要

Stroke rapid-response ("code stroke") teams facilitate the evaluation and treatment of patients presenting to emergency departments (EDs). Little is known about the usefulness of code stroke systems for patients hospitalized primarily for other conditions. We hypothesized that the yield of code stroke evaluations would be lower in hospitalized than in ED patients, and sought to identify potential targets for quality improvement efforts. Diagnoses and management of in-hospital and ED code stroke patients were assessed retrospectively in a Joint Commission-certified primary stroke center over a 1-year period. A total of 93 in-hospital and 204 ED code strokes were identified during this period. Compared with the ED patients, the hospitalized patients were less likely to have had a stroke/transient ischemic attack (26.8% vs 51.4%; P <.0001) and less likely to have been treated with a thrombolytic agent (odds ratio, 0.27; 95% confidence interval, 0.07-0.97: P =.03). Conditions not necessitating immediate neurologic care accounted for 63.4% of in-hospital strokes, compared with 31.3% of ED code strokes (P <.0001). "Altered mental status" was the sole presenting symptom in 48% of the hospitalized patients, compared with only 10% of ED patients (P <.0001), and was the only clinical feature independently associated with a stroke mimic in the hospitalized patients (odds ratio, 63.52; 95% confidence interval, 7.37-547.69; P =.0002). There was no association between a final diagnosis of a stroke mimic and patient age, sex or race-ethnicity or nursing shift. The proportions of patients with acute ischemic stroke and patients treated with thrombolytics after activation of in-hospital code stroke were small, and were lower than those of patients with ED code stroke in the same hospital over the same time period. Developing a standardized assessment protocol for hospitalized patients with altered mental status may improve the efficacy of care.
机译：中风快速反应（“中风”）团队有助于评估和治疗急诊科（ED）的患者。对于主要因其他情况而住院的患者，使用代码笔划系统的有用性知之甚少。我们假设住院的代码笔划评估结果要比ED患者的要低，并试图确定质量改进工作的潜在目标。在联合委员会认证的原发性中风中心进行了为期一年的回顾性评估，以评估院内和ED码中风患者的诊断和治疗情况。在此期间，共确定了93例住院和204例ED代码中风。与ED患者相比，住院患者发生中风/短暂性脑缺血发作的可能性较小（26.8％比51.4％; P <.0001），并且接受溶栓剂治疗的可能性较小（优势比为0.27; 95％置信区间，0.07-0.97：P = .03）。不需要立即进行神经科护理的疾病占院内卒中的63.4％，而ED代码卒中的占31.3％（P <.0001）。 “改变的心理状态”是48％的住院患者的唯一表现症状，而只有10％的ED患者（P <.0001），并且是住院患者中唯一与卒中模仿相关的临床特征（比值比为63.52; 95％置信区间为7.37-547.69; P = .0002）。卒中模拟的最终诊断与患者的年龄，性别或种族，种族或护理转变之间没有关联。急性缺血性卒中患者和激活院内卒中后接受溶栓剂治疗的患者比例较小，且均低于同期同一医院内ED卒中患者的比例。为精神状态改变的住院患者制定标准化的评估方案可能会改善护理效果。

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