Stroke：大的卒中单元能够提高卒中治疗效果并缩短住院时间

专门的卒中单元能够改善卒中患者的预后，但是尚没有哪种临床评分系统能够评价大量患者的治疗花费及临床预后。丹麦Aarhus大学医院的Marie Louise Svendsen 博士等进行研究发现：相较而言，大的卒中单元（收治病人数多的卒中单元）救治患者能够提高救治质量、缩短住院时间、减少费用。相关论文发表在stroke杂志2012年9月13日在线版上。

研究人员在全国范围内人群为基础的队列研究中纳入了2003年至2009年在丹麦入住卒中单元的63995位患者。预先收集暴露因素、预后和协变量等信息。对不同的卒中单元进行比较，根据患者及医院的特性进行校正。

结果：就诊大卒中单元的患者总体上预后好于那些就诊小卒中单元的患者。大卒中单元较小的卒中单元在卒中发病早期采取了更多的措施。(未校正差异为9.84%; 95% CI, 3.98–15.70)。大卒中单元救治与住院时间较短相关 (校正后比值, 0.49; 95% CI, 0.41–0.59) ，并能降低卒中后1年卧床时间 (校正后比值, 0.79; 95% CI, 0.70–0.87)。大小卒中单元之间救治死亡率没有差异。

研究人员得出结论：患者在大的卒中单元救治能够获得高质量的早期救护，能够较小的卒中单元减少住院时间。但是，两者之间的救治死亡率没有区别。

与卒中相关的拓展阅读：

• Stroke：变异EPO可以作为缺血性脑卒中药物干预的新选择
• Stroke：大的卒中单元能够提高卒中治疗效果并缩短住院时间
• EHJ：心率或可预测卒中预后
• Stroke：研究发现西欧国家近几十年来脑卒中死亡率下降而发病率增高
• Lancet Neurol：孤立性脑干症状预测后循环卒中
更多信息请点击：有关卒中更多资讯

doi: 10.1161/STROKEAHA.111.645184.
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Higher stroke unit volume associated with improved quality of early stroke care and reduced length of stay.

Svendsen ML, Ehlers LH, Ingeman A, Johnsen SP.

BACKGROUND AND PURPOSE:Specialized stroke unit care improves outcome among patients with stroke, but it is unclear whether there are any scale advantages in costs and clinical outcome from treating a larger number of patients. We examined whether the case volume in stroke units was associated with quality of early stroke care, mortality, and hospital bed-day use. METHODS:In a nationwide population-based cohort study, we identified 63 995 patients admitted to stroke units in Denmark between 2003 and 2009. Data on exposure, outcome, and covariates were collected prospectively. Comparisons were clustered within stroke units and adjusted for patient and hospital characteristics. RESULTS:Patients in high-volume stroke units overall had a better prognostic profile than patients in low-volume stroke units. Patients in high-volume stroke units also received more processes of care in the early phase of stroke compared with patients in low-volume stroke units (unadjusted difference, 9.84 percentage points; 95% CI, 3.98-15.70). High stroke unit volume was associated with shorter length of the initial hospital stay (adjusted ratio, 0.49; 95% CI, 0.41-0.59) and reduced bed-day use in the first year after stroke (adjusted ratio, 0.79; 95% CI, 0.70-0.87). No association between volume and mortality was found. CONCLUSIONS:Patients admitted to high-volume stroke units received a higher quality of early stroke care and spent fewer days in the hospital compared with patients in low-volume units. We observed no association between volume and mortality.