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首页> 外文期刊>Internal medicine journal >Metropolitan-rural divide for stroke outcomes: Do stroke units make a difference?
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Metropolitan-rural divide for stroke outcomes: Do stroke units make a difference?

机译：大都会农村划分的中风结果：行程单位有所作为吗？

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Background: Stroke care across Australian hospitals is variable. The impact on health outcomes, in particular levels of disability for patients in rural areas, is unclear. The aim of this study was to determine whether geographic location and access to stroke units are associated with differences in health outcomes in patients with acute stroke. Methods: Retrospective cohort study of consecutive eligible admissions from 32 hospitals (12 rural) in New South Wales between 2003 and 2007. Health status measured at discharge included level of independence (modified Rankin score: mRS) and frequency of severe complications during hospitalization. Multivariable analyses included adjustment for patient casemix and clustering. Results: Among 2254 eligible patients, 55% were treated in metropolitan hospitals. Stroke unit treatment varied significantly (rural 3%; metropolitan 77%). Age, gender and stroke type did not differ by location (mean age 74, 50% female). After adjusting for age, gender, ethnicity, important risk factors and validated stroke prognostic variables, patients treated in rural hospitals had a greater odds of dying during hospitalization compared with those treated in metropolitan hospitals (adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI) 1.03-2.05). There were no differences in mortality or frequency of severe complications between patients treated in rural and metropolitan hospitals when we adjusted for access to stroke units (aOR 1.00, 95% CI 0.62-1.61). Nevertheless, patients treated in rural hospitals were more dependent (mRS 3-5) at discharge (aOR 1.82, 95% CI 1.23-2.70) despite adjusting for stroke unit status. Conclusion: Patients with stroke treated in rural hospitals have poorer health outcomes, especially if not managed in stroke units.
机译：背景：澳大利亚医院的冲程护理是可变的。农村地区患者的对健康结果，特别是残疾水平的影响尚不清楚。本研究的目的是确定地理位置和对卒中单元的访问是否与急性中风患者的健康结果的差异有关。方法：在2003年至2007年间新南威尔士州的32家医院（12乡村）的连续符合条件入院的回顾性队列研究。在出院时测量的健康状况包括独立水平（改进的Rankin得分：Mrs）和住院期间严重并发症的频率。多变量分析包括患者Casemix和聚类的调整。结果：在2254名符合条件的患者中，55％的人在大都市医院治疗。行程单位治疗显着变化（农村3％;大都市77％）。年龄，性别和中风类型没有区别（平均74，50％的女性）。在调整年龄，性别，种族，重要的风险因素和验证的脑卒中预后变量后，与大都市医院（调整的赔率比（AOR）1.46，95％的信心相比，农村医院治疗的患者在住院期间死亡较大。间隔（CI）1.03-2.05）。当我们调整进入行程单元（AOR 1.00,95％CI 0.62-1.61）时，在农村和大都市医院治疗的患者与大都市医院治疗的患者之间的死亡率或严重并发症的频率没有差异。然而，尽管调整行程单位状况，但在农村医院治疗的患者在出院（AOR 1.82,95％CI 1.23-2.70）中仍更加依赖（3-5夫人）。结论：农村医院治疗中风的患者具有较差的健康成果，特别是如果在中风单元中管理。

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