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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Triage of Patients with Intracerebral Hemorrhage to Comprehensive Versus Primary Stroke Centers
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Triage of Patients with Intracerebral Hemorrhage to Comprehensive Versus Primary Stroke Centers

机译：脑内出血患者的术语与综合性与原代中风中心

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Objectives: The management of patients admitted with intracerebral hemorrhage (ICH) mostly occurs in an ICU. While guidelines recommend initial treatment of these patients in a neurocritical care or stroke unit, there is limited data on which patients would benefit most from transfer to a comprehensive stroke center where on-site neurosurgical coverage is available 24/7. As neurocritical units become more common in primary stroke centers, it is important to determine which patients are most likely to require neurosurgical intervention and transfer to comprehensive stroke centers. Materials and methods: This is a retrospective observational cohort study conducted at an academic comprehensive stroke center in the United States. Four-hundred-fifty-nine consecutive patients transferred or directly admitted to the neurocritical care unit from 2016-2018 with the primary diagnosis of ICH were included. Univariate statistics and multivariate regression were used to identify clinical characteristics associated with neurosurgical intervention, defined as undergoing craniotomy, ventriculostomy, or endovascular embolization of an arteriovenous malformation (AVM). Results: The following variables were associated with neurosurgical intervention in multivariate analysis: age (OR 0.38, 95% CI 0.27-0.55), admission Glasgow Coma Scale (OR 0.29, 95% CI 0.18-0.48), the presence of intraventricular hemorrhage (OR 2.82, CI 1.71-4.65), infratentorial location of ICH (OR 2.28, 95% CI 1.20-4.31), previous antiplatelet use (OR 2.04, 95% CI 1.24-3.34), and an AVM indicated on CT Angiogram (OR 2.59, 95% CI 1.19-5.63) were independently associated with the need for neurosurgical intervention. This was translated into a scoring system to help make quick triage decisions, with high sensitivity (99%, 95% CI 97-99%) and negative predictive value (98%, 95% CI 89-99%). Conclusions: Using previously well described predictors of severity in ICH patients, we were able to develop a scoring system to predict the need for neurosurgical intervention with high sensitivity and negative predictive value.
机译：目的：脑出血（ICH）患者的治疗大多发生在ICU。虽然指南建议这些患者在神经重症监护或卒中单元进行初步治疗，但关于哪些患者最能从转移到综合性卒中中心中获益的数据有限，该中心可全天候提供现场神经外科服务。随着神经关键单元在初级卒中中心变得越来越常见，确定哪些患者最有可能需要神经外科干预并转移到综合卒中中心非常重要。材料和方法：这是一项在美国学术综合中风中心进行的回顾性观察性队列研究。纳入了自2016年至2018年期间转移或直接入住神经重症监护病房并初步诊断为ICH的连续459名患者。采用单变量统计和多变量回归分析来确定与神经外科干预相关的临床特征，定义为开颅手术、脑室造瘘术或动静脉畸形（AVM）的血管内栓塞。结果：在多变量分析中，以下变量与神经外科干预相关：年龄（OR 0.38，95%CI 0.27-0.55）、入院格拉斯哥昏迷评分（OR 0.29，95%CI 0.18-0.48）、脑室内出血（OR 2.82，CI 1.71-4.65）、脑出血幕下位置（OR 2.28，95%CI 1.20-4.31）、既往抗血小板使用（OR 2.04，95%CI 1.24-3.34），CT血管造影显示的AVM（OR 2.59，95%可信区间1.19-5.63）与神经外科干预的需要独立相关。这被转化为一个评分系统，以帮助快速做出分类决策，具有高灵敏度（99%，95%可信区间97-99%）和阴性预测值（98%，95%可信区间89-99%）。结论：使用之前对脑出血患者严重程度的预测因子，我们能够开发一个评分系统，以预测神经外科干预的需要，具有较高的敏感性和阴性预测价值。

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