급성 뇌경색 환자에서 뇌졸중치료실과 일반병동 치료 후 사망률과 의존성의 차이
Differences of Mortality and Dependence Between Stroke Unit and General Ward Care in Acute Ischemic Stroke Patients
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Background: There is strong evidence for the efficacy of stroke unit (SU) care, which has become a common practice in other developed countries but is available only in a small number of centers in Korea. This late introduction of SU care in Korea can be at least partly attributed to doubts about its benefits on patient outcomes compared to general ward (GW) care in our routine practice. Methods: Based on a prospective stroke registry, we identified 1,300 acute stroke patients hospitalized in either SUs (n=195) or GWs (n=1,105) from January 2004 to June 2008. Clinical outcomes such as fatality and disability rates were compared using propensity score matching in the total cohort. Additional statistical adjustments were performed using stepwise logistic regression analyses with the backward elimination method for potential confounders. Results: The baseline characteristics did not differ significantly between patients admitted to SUs (n=195) and their matched controls (n=386). The 3-month dependency rate was 17.4% in SUs and 21.0% in GWs (p=0.31), and the case fatality rates were 1.5% and 8.0% (p<0.001), respectively. Adjusted odds ratios for SU care were 0.49 for dependency (95% confidence interval [CI]=0.22-1.08) and 0.17 for death (95% CI=0.04-0.83). Conclusions: This study showed that SU care reduces fatality rates and improves functional outcomes, which indicates the need to implement more SUs in Korea.
Abstract
Background: There is strong evidence for the efficacy of stroke unit (SU) care, which has become a common practice in other developed countries but is available only in a small number of centers in Korea. This late introduction of SU care in Korea can be at least partly attributed to doubts about its benefits on patient outcomes compared to general ward (GW) care in our routine practice. Methods: Based on a prospective stroke registry, we identified 1,300 acute stroke patients hospitalized in either SUs (n=195) or GWs (n=1,105) from January 2004 to June 2008. Clinical outcomes such as fatality and disability rates were compared using propensity score matching in the total cohort. Additional statistical adjustments were performed using stepwise logistic regression analyses with the backward elimination method for potential confounders. Results: The baseline characteristics did not differ significantly between patients admitted to SUs (n=195) and their matched controls (n=386). The 3-month dependency rate was 17.4% in SUs and 21.0% in GWs (p=0.31), and the case fatality rates were 1.5% and 8.0% (p<0.001), respectively. Adjusted odds ratios for SU care were 0.49 for dependency (95% confidence interval [CI]=0.22-1.08) and 0.17 for death (95% CI=0.04-0.83). Conclusions: This study showed that SU care reduces fatality rates and improves functional outcomes, which indicates the need to implement more SUs in Korea.
참고문헌 (20)
- Collaborative systemic review of the randomized trials of organized inpatient (stroke unit) care after stroke, "Stroke Unit Trialists’ Collaboration", BMJ, 314, pp.1151~1159 (1997)
- The European Stroke Organisation (ESO) Executive Committee ESO Writing Committee, "Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008", Cerebrovasc Dis, 25, pp.457~507 (2008)
- Adams HP Jr, "Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association", American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists, 2007, pp.38, 1655~1711
- Langhorne P, "Association between physiological homeostasis and early recovery after stroke", Stroke, 31, pp.2518~2519 (2000)
- Lees KR, "Blood pressure control after acute stroke", J Hypertens Suppl, 14, pp.S35~S38 (1996)
- Sulter G, "Continuous pulse oximetry in acute hemiparetic stroke", J Neurol Sci, 179, pp.65~69 (2000)
- Sulter G, "From stroke unit care to stroke care unit", J Neurol Sci, 162, pp.1~5 (1999)
- Kim SH, "Clinical Usefulness of stroke Unit: The Comparison of in-hospital Treatment Outcomes between Stroke Unit and General Ward Cares", Korean J Stroke, 6, pp.145~150 (2001)
- Rosenbaum PR, "The central role of the propensity score in observational studies for causal effects", Biometrika, 70, pp.41~55 (1983)
- D’Agostino RB Jr, "Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group", Stat Med, 17, pp.2265~2281 (1998)
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST: Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- Van Swieten JC, "Interobserver agreement for the assessment of handicap in stroke patients", Stroke, 19, pp.604~607
- Kalra L, "Alternative strategies for stroke care: a prospective randomised controlled trial", Lancet, 356, pp.894~899 (2000)
- Seenan P, "units in their natural habitat: Systematic review of observational studies", Stroke, 38, pp.1886~1892 (2007)
- 윤두상, "병원기반 코호트에서 급성 허혈성 뇌졸중 및 일과성 뇌허혈 환자의 치명률 및 합병증이 장기 예후에 미치는 영향", 대한신경과학회지, 22(5), pp.433~439 (2004), 대한신경과학회
- Bae HJ, "In- hospital medical complications and long-term mortality after ischemic stroke", Stroke, 36, pp.2441~2445 (2005)
- Evans A, "Can differences in management processes explain different outcomes between stroke unit and stroke-team care?", Lancet, 358, pp.1586~1592 (2001)
- Cadilhac D, "Multicenter comparison of processes of care between Stroke Units and conventional care wards in Australia", Stroke, 35, pp.1035~1040 (2004)
- Treib J, "Treatment of stroke on an intensive stroke unit: a novel concept", Intensive Care Med, 26, pp.1598~1611 (2000)
- Busse O, "Stroke units and stroke services in Germany", Cerebrovasc Dis, 15, pp.8~10 (2003)