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进入内血管血栓切除术:驾驶时间到综合性中风中心是否比农村更重要?
Foad Taghdiri1, Manav V Vyas1,2,3,4, Moira K Kapral3,4,5,6,7
1Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
概括
随着较长的驾驶距离到综合性中风中心 (CSCs),急性中风血栓切除的机会显著减少,而血栓溶解仍然是可以获得的. 这突显了对时间敏感的中风护理的差异,特别是在偏远地区.
科学领域:
- 神经学 神经学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性中风治疗是时间敏感的,地理差异影响患者获得护理.
- 这项研究调查了驾驶距离到综合性中风中心 (CSC) 和农村地区如何影响加拿大安大略省的血栓切除和血栓溶解的利用情况.
研究的目的:
- 检查到最近的CSC和农村地区的驾驶距离与机械血栓切除和急性缺血性中风的血栓溶解的使用之间的关联.
- 确定获得先进中风治疗的地理差异.
主要方法:
- 用2017-2022年行政数据对急性缺血性中风住院的成年人进行回顾性队列研究.
- 使用安大略省道路网络档案和患者邮政编码计算的驾驶时间;按邮政编码分类的乡村地区.
- 多变量后勤回归分析了驾驶距离 (使用受限立方线建模) 和用血栓切除或血栓溶解治疗之间的关联.
主要成果:
- 增加到CSC的驾驶时间与降低血栓切除率非线性相关.
- 距离医院120分钟的患者患血栓切除的可能性降低20%,距离医院240分钟的患者患血栓切除的可能性降低60%.
- 驾驶时间没有显著影响血栓溶解率;与大型城市地区相比,在城市和小镇环境中使用血栓切除术是相似的.
结论:
- 在整个安大略省,血栓切除术的准入是公平的,但血栓切除术的准入受到增加到CSC的驾驶距离的限制.
- 为了公平地提供血栓切除术,需要创新的医疗保健政策和基础设施开发,以克服地理障碍.
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