急性缺血性腦中風病患延遲到醫相關因素之探討
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(2) S37. 1. (N = 477) (N = 126). (N = 351). p. %. n. %. N. %. 89. 71.2. 250. 72.7. 339. 72.3. 0.752. 33. 26.2. 77. 21.9. 110. 23.1. 0.331. 31. 24.8. 63. 18.3. 94. 20.2. 0.117. 22. 17.6. 60. 17.4. 82. 17.4. 0.958. 38. 30.2. 33. 9.4. 71. 14.9. < 0.001. 14. 11.2. 49. 14.2. 63. 13.4. 0.399. 12. 9.6. 45. 13.0. 57. 12.1. 0.312. 15. 11.9. 16. 4.6. 31. 6.5. 0.004. 10. 7.9. 18. 5.1. 28. 5.9. 0.250. 7. 5.6. 14. 4.1. 21. 4.5. 0.476. 4. 3.2. 11. 3.2. 15. 3.2. 0.995. 4. 3.2. 4. 1.1. 8. 1.7. 0.127. n. SPSS for Windows 9.0 (. ) 2. test. t test. multiple logistic regression. [5] 2 35. 54.9% 91. 67.9. 66.9%. 65. 67.5% 18.4%. (. 44.4%. 1). 37.1%. (44.7%). 24.5% 66.0% (45.5%). [5] (21.0%) (TOAST). (17.0%). (16.5%). [3]. (61.9%) (38.2%) (61.1%. 38.7%). 25.1% 29.9%. (93.7%) 56.1%. (51.9%). (19.4%).
(3) S38. 2. (N = 477) (N = 126). (N = 351) %. p. n. %. 73. 57.9. 189. 53.8. 262. 54.9. 53. 42.1. 162. 46.2. 215. 45.1. <65. 49. 38.9. 109. 31.3. 158. 33.1. ≥65. 77. 61.1. 242. 68.9. 319. 66.9. n. %. N. 0.429. (. 0.109. ). 67.9. 11.5. 68.0. 10.6. 67.9. 0.946. 10.8. 0.834 86. 68.3. 236. 67.2. 322. 67.5. 40. 31.7. 115. 32.8. 155. 32.5 < 0.001. 78. 61.9. 134. 38.2. 213. 44.4. 48. 38.1. 129. 36.8. 177. 37.1. 0. 0.00. 88. 25.1. 88. 18.4. 37. 29.4. 110. 31.3. 147. 30.8. 77. 61.1. 136. 38.7. 209. 44.7. 12. 9.5. 105. 29.9. 121. 24.5. < 0.001. < 0.001 118. 9.3. 197. 56.1. 315. 66.0. 8. 6.3. 154. 43.9. 162. 34.0 < 0.001. 37. 29.4. 44. 12.5. 81. 17.0. 32. 25.4. 68. 19.4. 100. 21.0. 35. 27.8. 182. 51.9. 217. 45.5. 22. 17.5. 57. 16.2. 79. 16.5. (16.2%). (12.5%). 27.8%. 25.4%. 17.5%. 29.4%. 2 (. 23.1%). (. 17.4%). ( (. 20.2%). (. 14.9%). 6.5%) 1.94. 6% 2.22. 1.84 (p < 0.001). 72.3%.
(4) S39. 3. (N = 477) n (%). (. n (%). (AOR). 73 (27.9). 189 (72.1). 1. 53 (24.7). 162 (75.3). 1.04. 49 (31.0). 109 (69.0). 1. 77 (24.1). 242 (75.9). 1.50. 86 (26.7). 236 (73.3). 1. 40 (25.8). 115 (74.2). 0.96. 95%. 0.62. 1.74. 0.879. 2.56. 0.56. 1.65. 1.54. 6.21. 1.02. 5.77. 0.69. 2.32. ). <64 65. 38 (53.5). 33 (46.5). 1. 88 (21.7). 318 (78.3). 3.09 **. 15 (48.4). 16 (51.6). 1. 111 (24.9). 335 (75.1). 78 (36.8). 134 (63.2). 1. 48 (27.1). 129 (72.9). 1.27. 48 (27.1). 88 (100.0). 2.42 *. 7.4E + 09. 37 (25.2). 110 (74.8). 77 (36.2). 136 (63.8). 0.60 *. 0.31. 1.14. 12 (10.3). 105 (89.7). 0.80. 0.30. 2.12. 118 (37.5). 197 (62.5). 1. 8 (4.9). 154 (95.1). 7.69 ***. 3.49. 16.94. 37 (45.7). 44 (54.3). 1. 32 (32.0). 68 (68.0). 1.32. 0.62. 2.83. 35 (16.1). 182 (83.9). 3.12 **. 1.54. 6.32. 22 (27.8). 57 (72.2). 2.70 *. 1.18. 6.17. 1. *p < 0.05, **p < 0.01, ***p < 0.001.. ( p < 0.001). 30.2%. (11.9%. 6.5%. 9.4% 3.1. p < 0.01 ). (. Adjusted Odds Ratio (AOR) = 3.09 3. (multiple logistic. 95%. (95% CI). 1.54 6.21. p < 0.01). 2.4. regression) 2.42 (. 95% CI. 1.02 5.77. (AOR =. p < 0.05). ). (AOR = 0.60 95% CI. 0.31 1.14 7.7. p < 0.05) (AOR = 7.69. 95% CI.
(5) S40. 3.49 16.94. p < 0.001) 3.1. 3.12. 95% CI. 1.54 6.32. 2.70. 95% CI. 1.18 6.17. 2.7. 65. (AOR =. p < 0.01. 74. 55. AOR =. p < 0.05). [6,9,13] [11,17]. Azzimondi. [6] Fogelholm. [17]. [7]. 3 Derex. [9]. [7,10] 18.4%. [4-12]. ( 29%. ). 59%. [19] 2.22. 1.84. 26.4% 37.5%. Rashmi. [4,5,8,9,11-15] [20] Williams. [5]. [18] Morris. [11] [5,6-. [6,8,9,11,12] Menon. Derex. [9]. 8,13,15,16]. [13] (45.5%). Williams Lacy. [14] [8]. 2.22. 1.84 (p < 0.001).
(6) S41. ( ). 1. Baron JC, von Kummer R, del Zoppo GJ. Treatment of acute ischemic stroke. Challenging the concept of a rigid and universal time window. Stroke 1995;26:221921. 2. 2001;3:112-20 3. Adams HP, Bendixen BH. Kappelle LJ, et al. 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 1993;24:35-41. 4. Barsan WG, Brott TG, Broderick JP, et al. Time of hospital presentation in patients with acute stroke. Arch Intern Med 1993;22:2558-61. 5. Williams LS, Bruno A, Rouch D, et al. Stroke patients' knowledge of stroke. Influence on time to presentation. Stroke 1997;28:912-5. 6. Azzimondi G, Bassein L, Fiorani L, et al. Variables associated with hospital arrival time after stroke: effect of delay on the clinical efficiency of early treatment. Stroke 1997;28:537-42. 7. Yip PK, Jeng JS, Lu CJ. Hospital arrival time after onset of different types of stroke in greater Taipei. J. Formos Med Assoc 2000;99:532-7. 8. L a c y C R , S u h D C , B u e n o M , e t al. Delay in presentation and evaluation for acute stroke: stroke time registry for outcomes knowledge and epidemiology (S.T.R.O.K.E.). Stroke 2001;32:63-9. 9. Derex L, Adeleine P, Nighoghossian N, et al. Factors influencing early admission in a French stroke unit. Stroke 2002;33:153-9. 10. Anderson NE, Broad JB, Bonita R. Delays in hospital admission and investigation in acute stroke. BMJ 1995;311:162. 11. Morris DL, Rosamond W, Madden K, et al. Prehospital and emergency department delays after acute stroke: the genentech stroke presentation survey. Stroke 2000;31:2585-90. 12. Morris DL, Rosamond WD, Hinn AR, et al. Time delays in accessing stroke care in the emergency department. Acad Emerg Med 1999;6:218-23. 13. Menon SC, Pandey DK, Morgenstern LB. Critical factors determining access to acute stroke care. Neurology 1998;51:427-32. 14. Williams JE, Rosamond WD, Morris DL. Stroke symptom attribution and time to emergency department arrival: the delay in accessing stroke healthcare study. Acad Emerg Med 2000;7:93-6. 15. Wester P, Radberg J, Lundgren B, et al. Factors associated with delayed admission to hospital and inhospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 1999;30:40-8. 16. 1998;45:22-8 17. Fogelholm R, Murros K, Rissanen A, et al. Factors delaying hospital admission after acute stroke. Stroke 1996;27:398-400. 18. 1996;7:61-7 19. 1997;20:95-7 20. Kothari R, Sauerbeck L, Jauch E, et al. Patients' awareness of stroke sings, symptoms, and risk factors. Stroke 1997;28:1871-5..
(7) S42. Factors Associated with Hospital Arrival Delays After Acute Ischemic Strokes 1. 2. 1. Yi-hsiu Tsai, Ming-Hui Sun, Chiu-Mei Chen , Hsien-Wen Kuo , Li-Chen Hung Stroke Center, Kuang Tien General, 1 2. Department of Nursing, Hungkuang University,. Department of Public Health, China Medical University, Taichung, Taiwan, R.O.C.. Objectives. This study was designed to investigate the factors associated with hospital arrival delays after stroke attacks. Methods. Four hundred seventy-seven patients with ischemic strokes were enrolled in this prospective study. Patients were divided into either an "On-time " group (26.4%, within 3 hours) or a "Delay" group (73.6%, over 3 hours) according to their hospital arrival times. Data were collected from medical records, patients and family members by a structured questionnaire. Results. Variables including gender, age and recurrent status did not significantly affect the delay in hospital arrival. Multiple logistic regression analysis showed that the significant factors which affected hospital arrival times were consciousness (adjusted odds ratio, AOR = 3.1), absence of nausea or vomiting symptoms (AOR = 2.4), outpatient status (AOR = 7.7), small-vessel occlusion (AOR = 3.1) and other factors (AOR = 2.7). Conclusions. A reduction in hospital arrival delays can be achieved by increasing public awareness of the seriousness of stroke symptoms and the need to seek medical or other attention promptly after stroke onset. ( Mid Taiwan J Med 2003;8 Supplment:S36-42 ). Key words acute, delay, hospital arrival, ischemic stroke. Received : January 2, 2003.. Revised : March 12, 2003.. Accepted : March 14, 2003. Address reprint requests to : Li-Chen Hung, Department of Nursing, Hungkuang University, 34 Chung-Chie Road, Sha Lu, Taichung 433, Taiwan, R.O.C..
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