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首页> 外文期刊>Prehospital emergency care >Effect of Acute Stroke Care Regionalization on Intravenous Alteplase Use in Two Urban Counties
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Effect of Acute Stroke Care Regionalization on Intravenous Alteplase Use in Two Urban Counties

机译：急性中风护理区域化对两个城市静脉内普通普酶使用的影响

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Importance: Intravenous alteplase is an effective treatment for acute ischemic stroke and is significantly underutilized. It is known that stroke centers with accreditation are more likely to provide intravenous alteplase treatment, and therefore, policies that increase the number of certified stroke centers and the number of acute ischemic stroke patients routed to these centers may be beneficial. Objective: To determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Design: An observational, longitudinal study to examine treatment trends with log-link binomial regression modeling to compare pre-post policy implementation changes in the proportions of patients treated with intravenous alteplase in two counties. Setting: Two urban counties, Santa Clara and San Mateo, in the western region of US that regionalized acute stroke care between 2005 and 2010. Participants: Patients with primary or secondary diagnosis of stroke were identified from the statewide patient discharge database by International Classification of Diseases (ICD-9) codes. We linked ambulance and hospital data to create complete patient care records. Main outcomes and measures: Stroke treatment, defined as a documented primary procedure code for intravenous alteplase administration (ICD-9: 99.10). Results: In Santa Clara County, intravenous alteplase was administered to 35 patients (1.7%) in the pre-regionalization period and 240 patients (2.1%) in the post-regionalization period. In San Mateo County, intravenous alteplase was administered to 29 patients (1.3%) in the pre-policy period and 135 patients (3.2%) in the post-policy period. After regionalization of stroke care, intravenous alteplase increased two-fold in San Mateo County [adjusted RR 2.20, p = 0.003, 95% CI (1.31, 3.69)] but did not show any statistically significant change in Santa Clara County [adjusted RR 1.10, p = 0.55, 95% CI (0.80, 1.51)]. In the post-regionalization phase, when compared with Santa Clara County, we found that San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers and more frequent use of intravenous alteplase at stroke centers. Conclusions: Our findings suggest that greater post-regionalization improvements in San Mateo County contributed to significantly better county-level thrombolysis use than Santa Clara County.
机译：重要性：静脉内的Alteplase是急性缺血性卒中的有效治疗方法，并且显着未充分利用。众所周知，具有认证的中风中心更有可能提供静脉内普通酶治疗，因此，增加认证中风中心数量的政策和急性缺血性卒中患者的数量可能是有益的。目的：判断是否增加对原发性中风中心（区域化）的进入导致急性缺血性卒中患者静脉内普通酶使用的增加。设计：观察性，纵向研究，以研究对数量二项式回归建模的治疗趋势，以比较两次静脉内普拉酶对静脉内普拉酶的比例的后政策实施变化。环境：两座城市县，圣克拉拉和圣马特奥，在美国西部地区，2005年至2010年间区域化急性中风护理。参与者：通过国际分类，从州所有患者放电数据库中鉴定了卒中初级或次要诊断的患者疾病（ICD-9）代码。我们联系了救护车和医院数据以创建完整的患者护理记录。主要结果和措施：中风治疗，定义为静脉内普拉基酶管理（ICD-9：99.10）的记录的主要过程代码。结果：在Santa Clara County，静脉内普雷酶在区域化期间和240名患者（2.1％）中施用至35名患者（1.7％）。在圣马特奥县，在政策后期间和135名患者中施用静脉内普雷酶（1.3％），政策后期限为135名患者（3.2％）。在中风护理区域化后，静脉内普拉酶在San Mateo County中增加了两倍[调整后的RR 2.20，P = 0.003,95％CI（1.31,3.69）]但没有显示圣克拉拉县的任何统计上大量变化[调整后的RR 1.10 ，P = 0.55,95％CI（0.80,1.51）]。在区域后化阶段，与圣克拉拉县相比，我们发现San Mateo County对护理手术检测的更大变化，对初中脑卒中的次数较多，并且在中风中心常常使用静脉内普雷酶。结论：我们的研究结果表明，三马特县的大型区域化改进促进了比圣克拉拉县的明显更好的县级溶栓用途。

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