Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with tele...Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with telestroke. Multiple linear regression for departure time from ED (DT), quantile regression for length of in-hospital stay (LOS), and Kaplan-Meier estimator with Cox proportional hazards model for one-year survival (SV) were performed. Results: 192 patients included were categorised according to IFT. Mechanical thrombectomy was performed in 50% who had been transferred. Differences were found in DT, discharge disposition and LOS. An inverse relationship existed between DT and NIHSS. The strongest predictor of LOS was TACS (β = 3.14 [0.03 - 8.49];p = 0.005). SV was related to IFT (HR 4.68 [1.37 - 16.07];p = 0.014), age (HR 1.1 [1.04 - 1.17]), BI Conclusions: Shared decision-making with a stroke unit through telemedicine enabled a standardised clinical management in a non-metropolitan setting. Several improvement opportunities were identified: multimodal computed tomography availability before transfer, as well as optimization of response time and training in neurosonology of emergency physicians.展开更多
目的探讨分析急诊脑卒中识别评分量表(the recognition of stroke in the emergency room scale,ROSIER)对急诊室可疑脑卒中患者的快速筛选价值。方法参照《中国脑血管病防治指南2007》,急诊医师在急诊室使用ROSIER对可疑脑卒中患者进...目的探讨分析急诊脑卒中识别评分量表(the recognition of stroke in the emergency room scale,ROSIER)对急诊室可疑脑卒中患者的快速筛选价值。方法参照《中国脑血管病防治指南2007》,急诊医师在急诊室使用ROSIER对可疑脑卒中患者进行筛查,综合临床诊断将根据患者的急诊头颅CT或MRI扫描,并结合神经专科医师意见制定。计算ROSIER灵敏度、特异度、阴性预测值、阳性预测值、相关系数和Kappa值。结果本次研究的216例可疑脑卒中患者中,ROSIER的灵敏度90.0%,特异度84.2%,阳性预测值91.3%,阴性预测值82.1%,Kappa值为0.74,相关系数为0.59。在急诊室使用ROSIER对可疑脑卒中患者进行快速筛选,与综合临床诊断结果相关联,差异有统计学意义(P<0.05)。ROSIER对可疑脑卒中患者筛选结果的一致性为中高度一致。结论在急诊室,急诊医师使用ROSIER对可疑脑卒中患者进行筛选具有一定使用价值。展开更多
目的研究急诊分诊护士使用面、臂、言语、时间评分量表(the Face Arm Speech Time,FAST)在急诊室对可疑脑卒中患者进行快速评估和分诊的价值。方法参照FAST,急诊分诊护士在急诊室登记护士站对可疑脑卒中患者进行快速评估和分诊,对患者...目的研究急诊分诊护士使用面、臂、言语、时间评分量表(the Face Arm Speech Time,FAST)在急诊室对可疑脑卒中患者进行快速评估和分诊的价值。方法参照FAST,急诊分诊护士在急诊室登记护士站对可疑脑卒中患者进行快速评估和分诊,对患者的诊疗过程进行随访,参考综合临床诊断,计算FAST的评估时间、灵敏度、特异度、阳性似然比、阴性似然比、相关系数和Kappa值。结果本次研究中,急诊分诊护士使用FAST对114例可疑脑卒中患者在急诊室登记护士站进行了快速评估和分诊,平均耗时35秒,FAST的灵敏度76.9%、特异度69.4%、假阳性率30.6%、假阴性率23.1%、阳性似然比2.51、阴性似然比0.33、Kappa值0.463,相关系数0.420;参考综合临床诊断,由急诊分诊护士在急诊室登记护士站使用FAST对可疑脑卒中患者进行快速评估和分诊,差异有统计学意义(P<0.05)。FAST对可疑脑卒中患者筛选结果的一致性为中高度一致。结论在急诊室,由急诊分诊护士使用FAST对可疑脑卒中患者进行快速评估和分诊有一定的价值。展开更多
目的：探讨急诊脑卒中识别评分量表（the recognition of stroke in the emergency room,ROSIER）和面、臂、言语、时间评分量表（facial drooping,arm weakness,speech difficulties and time,FAST）对急诊疑似卒中患者的筛查价值。方...目的：探讨急诊脑卒中识别评分量表（the recognition of stroke in the emergency room,ROSIER）和面、臂、言语、时间评分量表（facial drooping,arm weakness,speech difficulties and time,FAST）对急诊疑似卒中患者的筛查价值。方法：对237例芜湖市第二人民医院经急诊就诊疑似脑卒中患者,使用ROSIER和FAST评分量表进行筛查,并根据患者的头颅CT或磁共振,结合专科诊疗明确最终确诊,分析比较两种量表的应用价值。结果：237例患者最终确诊卒中177例,非卒中患者60例。两组患者在年龄﹑吸烟史、饮酒史、高血压、ROSIER评分、FAST评分差异有统计学意义（P均〈0.05）。Logistic回归分析发现,年龄（OR=1.051,95%CI：1.020~1.084,P=0.001）﹑高血压病（OR=2.721,95%CI：1.190~6.224,P=0.018）和ROSIER评分（OR=92.960,95%CI：8.098~167.064,P=0.001）与脑卒中患者显著相关。ROSIER评分量表的敏感度为79.66%,特异度为86.66%,阳性预测值为94.63%,阴性预测值为59.09%,FAST评分量表的敏感度为76.27%,特异度为81.66%,阳性预测值为92.46%,阴性预测值为53.85%。结论：在急诊急救中,对可疑脑卒中患者的临床筛查,ROSIER评分量表优于FAST评分量表。展开更多
文摘Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with telestroke. Multiple linear regression for departure time from ED (DT), quantile regression for length of in-hospital stay (LOS), and Kaplan-Meier estimator with Cox proportional hazards model for one-year survival (SV) were performed. Results: 192 patients included were categorised according to IFT. Mechanical thrombectomy was performed in 50% who had been transferred. Differences were found in DT, discharge disposition and LOS. An inverse relationship existed between DT and NIHSS. The strongest predictor of LOS was TACS (β = 3.14 [0.03 - 8.49];p = 0.005). SV was related to IFT (HR 4.68 [1.37 - 16.07];p = 0.014), age (HR 1.1 [1.04 - 1.17]), BI Conclusions: Shared decision-making with a stroke unit through telemedicine enabled a standardised clinical management in a non-metropolitan setting. Several improvement opportunities were identified: multimodal computed tomography availability before transfer, as well as optimization of response time and training in neurosonology of emergency physicians.
文摘目的探讨分析急诊脑卒中识别评分量表(the recognition of stroke in the emergency room scale,ROSIER)对急诊室可疑脑卒中患者的快速筛选价值。方法参照《中国脑血管病防治指南2007》,急诊医师在急诊室使用ROSIER对可疑脑卒中患者进行筛查,综合临床诊断将根据患者的急诊头颅CT或MRI扫描,并结合神经专科医师意见制定。计算ROSIER灵敏度、特异度、阴性预测值、阳性预测值、相关系数和Kappa值。结果本次研究的216例可疑脑卒中患者中,ROSIER的灵敏度90.0%,特异度84.2%,阳性预测值91.3%,阴性预测值82.1%,Kappa值为0.74,相关系数为0.59。在急诊室使用ROSIER对可疑脑卒中患者进行快速筛选,与综合临床诊断结果相关联,差异有统计学意义(P<0.05)。ROSIER对可疑脑卒中患者筛选结果的一致性为中高度一致。结论在急诊室,急诊医师使用ROSIER对可疑脑卒中患者进行筛选具有一定使用价值。
文摘目的研究急诊分诊护士使用面、臂、言语、时间评分量表(the Face Arm Speech Time,FAST)在急诊室对可疑脑卒中患者进行快速评估和分诊的价值。方法参照FAST,急诊分诊护士在急诊室登记护士站对可疑脑卒中患者进行快速评估和分诊,对患者的诊疗过程进行随访,参考综合临床诊断,计算FAST的评估时间、灵敏度、特异度、阳性似然比、阴性似然比、相关系数和Kappa值。结果本次研究中,急诊分诊护士使用FAST对114例可疑脑卒中患者在急诊室登记护士站进行了快速评估和分诊,平均耗时35秒,FAST的灵敏度76.9%、特异度69.4%、假阳性率30.6%、假阴性率23.1%、阳性似然比2.51、阴性似然比0.33、Kappa值0.463,相关系数0.420;参考综合临床诊断,由急诊分诊护士在急诊室登记护士站使用FAST对可疑脑卒中患者进行快速评估和分诊,差异有统计学意义(P<0.05)。FAST对可疑脑卒中患者筛选结果的一致性为中高度一致。结论在急诊室,由急诊分诊护士使用FAST对可疑脑卒中患者进行快速评估和分诊有一定的价值。
文摘目的：探讨急诊脑卒中识别评分量表（the recognition of stroke in the emergency room,ROSIER）和面、臂、言语、时间评分量表（facial drooping,arm weakness,speech difficulties and time,FAST）对急诊疑似卒中患者的筛查价值。方法：对237例芜湖市第二人民医院经急诊就诊疑似脑卒中患者,使用ROSIER和FAST评分量表进行筛查,并根据患者的头颅CT或磁共振,结合专科诊疗明确最终确诊,分析比较两种量表的应用价值。结果：237例患者最终确诊卒中177例,非卒中患者60例。两组患者在年龄﹑吸烟史、饮酒史、高血压、ROSIER评分、FAST评分差异有统计学意义（P均〈0.05）。Logistic回归分析发现,年龄（OR=1.051,95%CI：1.020~1.084,P=0.001）﹑高血压病（OR=2.721,95%CI：1.190~6.224,P=0.018）和ROSIER评分（OR=92.960,95%CI：8.098~167.064,P=0.001）与脑卒中患者显著相关。ROSIER评分量表的敏感度为79.66%,特异度为86.66%,阳性预测值为94.63%,阴性预测值为59.09%,FAST评分量表的敏感度为76.27%,特异度为81.66%,阳性预测值为92.46%,阴性预测值为53.85%。结论：在急诊急救中,对可疑脑卒中患者的临床筛查,ROSIER评分量表优于FAST评分量表。
