| Summary: | 碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 105 === Ischemic stroke is the major cause of disability and death in the word. Earlier treatment for ischemic stroke in emergency room(ER) brings better outcome. Rural Local Community Hospitals are responsible for most medical evens in the rural area. The aim of the study is survey the performance of managing patients diagnosed of acute ischemic stroke in rural Local Community Hospitals.
This study includes patients who admitted to ER in rural Local Community Hospitals and urban Medical Center since 2016 January 1 to 2016 July 31 and diagnosed of ischemic stroke. The characteristics of patients include age, gender, body mass index and cerebrovascular risk factors were recorded. The time of pre-hospital delay and the time from arrival at ER to completing brain Computed Tomography (CT) were recorded also. The change of National Institutes of Health Stroke Scale (NIHSS) during admission was defined as short-term prognosis and the change of Modified Rankin Scale (mRS) after 90 days was defined as long-term prognosis. Methods of descriptive statistics and inferential statistics were used to compared the difference between the two hospitals.
The result of this study were as follows: The patients in rural Local Community Hospitals had the same age and risk factors with those in Medical Center, but had higher initial NIHSS (8.8±8.4 v.s 6.3±7.1, p=0.04) and mRS(3.7±1.2 v.s 3.0±1.5, p=0.001). There were smaller proportion (5.9% v.s 20.8%, p=0.01) of patients with mild symptoms (NIHSS=0-1) and larger proportion (43.1% v.s 16.4%, p<0.001) of patients arriving at ER within 3 hours in rural Local Community Hospitals. Patients in rural Local Community Hospitals had better short-term outcome (-2.27±3.35 v.s -0.56±4.30, p=0.009) and the same long-term outcome (-1.21±1.26 v.s -1.01±1.297, p=0.35). Subgroup analysis for patients arriving within 3 hours showed the same prognosis between two hospitals. Better short-term prognosis is attributed to fewer mild stroke and lesser pre-hospital delay in rural Local Community Hospitals.
The rural Local Community Hospitals could manage patients diagnosed of ischemia stroke and brings the same prognosis with Medical Center. Earlier therapy brings better outcome and we suggest patients should be sent to the nearest hospital which was certificated as dedicated hospital of stroke.
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