التفاصيل البيبلوغرافية
| العنوان: |
Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke. |
| المؤلفون: |
Lahr, Maarten M. H.1 (AUTHOR) m.m.h.lahr@umcg.nl, Vroomen, Patrick C. A. J.1 (AUTHOR), Luijckx, Gert-Jan1 (AUTHOR), van der Zee, Durk-Jouke2 (AUTHOR), de Vos, Ronald3 (AUTHOR), Buskens, Erik4 (AUTHOR) |
| المصدر: |
International Journal of Stroke. Oct2014 Supplement, Vol. 9, p31-35. 5p. 1 Diagram, 2 Charts. |
| مستخلص: |
Background Treatment rates with intravenous tissue plasminogen activator vary by region, which can be partially explained by organizational models of stroke care. A recent study demonstrated that prehospital factors determine a higher thrombolysis rate in a centralized vs. decentralized model in the north of the Netherlands. Aim To investigate prehospital factors that may explain variation in thrombolytic therapy between a centralized and a decentralized model. Methods A consecutive case observational study was conducted in the north of the Netherlands comparing patients arriving within 4·5 h in a centralized vs. decentralized stroke care model. Factors investigated were transportation mode, prehospital diagnostic accuracy, and preferential referral of thrombolysis candidates. Potential confounders were adjusted using logistic regression analysis. Results A total of 172 and 299 arriving within 4·5 h were enrolled in centralized and decentralized settings, respectively. The rate of transportation by emergency medical services was greater in the centralized model (adjusted odds ratio 3·11; 95% confidence interval, 1·59–6·06). Also, more misdiagnoses of stroke occurred in the central model (P = 0·05). In postal code areas with and without potential preferential referral of thrombolysis candidates due to overlapping catchment areas, the odds of hospital arrival within 4·5 h in the central vs. decentral model were 2·15 (95% confidence interval, 1·39–3·32) and 1·44 (95% confidence interval, 1·04–2·00), respectively. Conclusions These results suggest that the larger proportion of patients arriving within 4·5 h in the centralized model might be related to a lower threshold to use emergency services to transport stroke patients and partly to preferential referral of thrombolysis candidates. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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