院外应用NIHSS评分对急救时间的影响

Influence of NIHSS score on pre-hospital care time

目的 探讨院外进行美国国立卫生研究院卒中量表(NIHSS)评分是否会影响急救时间。方法 依据ICD-10编码,筛选出2019年1月1日—12月31日经镇江市急救中心救治的所有符合纳入标准的脑卒中患者的病历资料进行分析,分析比较经NIHSS评分培训的院外急救人员(NIHSS组)和常规评估的急救人员(对照组)的总院外时间和现场滞留时间以及比较入院后到做CT的时间。结果 共有274例急性卒中患者,其中男性145例,女性129例,年龄33~89岁,平均(72±11)岁。所有患者的应急反应时间为7(2~15)min.,平均转运时间为12(1~22)min。NIHSS组与对照组患者的院外时间无统计学差异[86(65~128) min与84(56~140)min,P>0.05]。在现场停留时间分别为18(13~25)和16(11~23)(P>0.05)。院外NIHSS评分值为(5.2±5.7)分,院内医生NIHSS评分值为(4.2±5.9)分,院外略高于院内评分(P<0.05)。74.8%患者的院外和院内评分相差≤3分。在二次分析中,临床分类0~5分(轻度卒中)和6~40分(中度至重度卒中)的评价者间一致性为k=0.62,这表明一致性良好。结论 经过培训的院外急救医生可以在现场采用NIHSS作为准确的卒中严重程度量化工具,院外NIHSS评分不会影响急救时间。

Objective To explore whether NIHSS scoring before hospital affect semergency response time.Methods According to the ICD-10 code,the medical records of all stroke patients who met the inclusion criteria treated by Zhenjiang Emergency Center from January 1,2019 to December 31,2019 were selected and analyzed.The total pre-hospital time and on-site stay time of pre-hospital first aiders(NIHSS group)trained by NIHSS score and the routine assessed first aiders(control group),as well as the time to do CT after admission were compared.Results There were 274 patients with acute stroke,including 145 males and 129 females,aged from 33 to 89 years,with an average age of(72±11)years.The emergency response time of all patients was 7(2-15)minutes,and the average transit time was 12(1-22)minutes.There was no statistical difference in the pre-hospital time between NIHSS group and control group[86(65-128)minutes and 84(56-140)minutes,P>0.05].The stay time at the site was 18(13-25)and 16(11-13)respectively(P>0.05).The pre-hospital NIHSS score was(5.2±5.7),and the hospital doctor's NIHSS score was(4.2±5.9).The pre-hospital NIHSS score was slightly higher than the hospital score(P<0.05).The difference between pre-hospital and in hospital scores of 74.8%patients was≤3 points.In the secondary analysis,the consistency between the evaluators of clinical class ification of 0-5 points(mild stroke)and 6-40 points(moderate to severe stroke)was k=0.62,indicating good consistency.Conclusion The trained pre-hospital emergency doctors can use NIHSS as an accurate tool to quantify the severity of stroke on site,and NIHSS score performed outside the hospital does not increase the pre-hospital time.