Air Medical Transport for Acute Ischemic Stroke Patients: A Retrospective Cohort Study of National Trends Over an 8-Year Period.

Autor: Urdaneta A; Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA., Fisk C; Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA., Tandel MD; Quantitative Sciences Unit, Department of Medicine, Stanford Medicine, Palo Alto, CA., Garcia A; Quantitative Sciences Unit, Department of Medicine, Stanford Medicine, Palo Alto, CA., Govindarajan P; Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA. Electronic address: pgovinda@stanford.edu.
Jazyk: angličtina
Zdroj: Air medical journal [Air Med J] 2023 Nov-Dec; Vol. 42 (6), pp. 423-428. Date of Electronic Publication: 2023 Jul 07.
DOI: 10.1016/j.amj.2023.06.007
Abstrakt: Objective: Optimal management of ischemic stroke is time dependent. An understanding of patterns of air medical transport may identify disparities that could affect patient care.
Methods: In this 8-year (2007-2014) observational, retrospective, cohort study, we abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground).
Results: Among 149,751 hospitalized stroke patients who arrived by ambulance, the mean age was 81.6 years (standard deviation = 8.0 years), 62.1% were female (n = 93,007), and 86.3% were White (n = 129,268). Of these, 5,534 patients (3.7%) used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%; P < .001) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%; P < .001) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68; 95% confidence interval [CI], 0.64-0.72 and OR = 0.34; 95% CI, 0.32-0.37, respectively) and all racial minorities except American Natives (OR = 2.07; 95% CI, 1.57-2.73) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23; 95% CI, 1.09-1.38) and rural residents (OR = 1.34; 95% CI, 1.09-1.64). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57; 95% CI, 2.38-2.79).
Conclusion: Air ambulance use is independently associated with increased thrombolysis use for stroke, but disparities exist in both air ambulance and thrombolysis use. Further research into underlying causes for these disparities would be beneficial for systems and public health-based interventions for improving outcomes for ischemic stroke.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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