Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke

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• 作者：Phyo Kyaw Myint ; MD^* ; ^{phyo.myint@abdn.ac.uk} ; Andrew C. Kidd ; MBChB^&dagger ; ; Chun Shing Kwok ; MBBS^* ; ^&Dagger ; ; Stanley D. Musgrave ; MD^§ ; ; Oliver Redmayne ; BSc^‖ ; Anthony K. Metcalf ; MBChB^¶ ; ; Joseph Ngeh ; MD^# ; ^a ; Anne Nicolson ; MBBS^** ; Peter Owusu-Agyei ; MBChB^&dagger ; &dagger ; ; Raj Shekhar ; FRCP^&Dagger ; &Dagger ; ; Kevin Walsh ; MD^§ ; § ; ; Diana J. Day ; MSc^‖‖ ; Elizabeth A. Warburton ; PhD^‖‖ ; Max O. Bachmann ; PhD^‖ ; John F. Potter ; DM^‖ ; ^¶ ; ; on behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group
• 关键词：Stroke ; age ; computerized tomography ; outcome ; mortality
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：25
• 期：12
• 页码：3005-3012
• 全文大小：306 K
• 卷排序：25

文摘

Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan.MethodsWe used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated.ResultsOf the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]).ConclusionsOlder age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.