Analysis Of Related Factors Based On The Incidence Of Stroke And Hospitalization Registration Study

Objective:Form a standardized code scheme stroke for the terms of stroke,and explore the research model of informatization stroke registration with the connotation of TCM.To analyze the characteristics of stroke onset status in the real world and the factors related to pre-hospital delay,which will provide some assistance for the health public service policy-making,and further research on early TCM intervention on stroke in the future.Methods:The current study was divided into two parts.The first parts is about the process of development of structured stroke registration form.The second part is about the correlation between pre-hospital delay and the condition of stroke attack by a multicenter stroke registration study.Part 1:Based on the original achievements about stroke terms and clinical medical records,we sorted the terms’ connotation and denotation to compile the standardized TCM term set-stroke and form a standardized coding scheme,according to their semantic and related professional standard.We coded these terms and structure the framework by summarized the characters of registration form and clinical research needs,which could ensure the structuralization of terms and information collection.Then,we updated the stroke registration form,and inserted the new edition into our e-clinical data platform.Part 2:We extracted the clinical information from the stroke registration study in 15 grade 3 and first-class hospitals,and used the histogram or pie chart to analyze the characteristics of the process of diagnosis and treatment of stroke patients in the real world,such as patients’ basic information,medical history,family history,lifestyle habits and state of illness and medical information.We also took these information as the independent variable to explore the related factors with pre-hospital delay,using the multivariate logistic regression model and stepwise method,which is on the basis of single factor related analysis.Meanwhile,we tried to mining the GRI association rules(minimum support level:4%,minimum confidence level:15%,Lift>1)to find the correlation between OCSP/TOAST type(consequent)and TCM syndrome factors(antecedent).Results:Part 1:The standardized TCM term set-stroke has been compiled by finishing 910 articles of TCM terms.The terms has been standardized coded,making the e-clinical data platform more structured.Combining with the factors of stroke registration platform at home and abroad,the stroke registration form has been updated,which has 47 collection points,242 structured collection variable and a framework in five-dimensions.This form has been inserted into the e-clinical data platform for the clinical research in second part.Part 2:A total of 4547 stroke patients were extracted into this study according with the inclusive criteria.Patient age was 65.44±11.73 years old;44.0%of patients were retirees;only 7.7%of patients had an educational level of above the bachelor’s degree;the most widely per capita income of household was 2000-3000 yuan/month.The top 3 independent risk factors for stroke,including hypertension,stroke and diabetes were still the most familiar basic disease and family disease.The statistics of daily life habits showed the ratio of partial salty taste(salt>7g/d)was more than 40%,while the ratio of weak taste(salt<4g/d)was only 4%.Less than 16%of the patients had a habit of regular medical examination,and the proportion of patients who regularly examined blood pressure,blood glucose or blood lipid was far less than the proportion of patients with hypertension,diabetes or hyperglycemia.The study on the onset time showed the most cases happened at 7-11a.m.There were 1247 patients who had some transient symptoms in 2 months before the onset,according to the frequency from high to low in turn is:partial body weakness(11.15%),dizziness(10.36%),hemianesthesia(6.38%),difficulty in speaking(3.78%),tinnitus(1.71%),walking,deflection(1.35%),facial/tongue paralysis(0.83%),blurred version(0.59%),ataxia(0.43%)and partial body sweat out(0.25%).And the initial symptoms according to the sequence is:hemiplegia(56.07%),aphasia(30.28%),dizziness(22.57%),hemianesthesia(18.70%),facial/tongue paralysis(7.21%),headache(4.89%),consciousness disorder(4.44%),ataxia(2.37%),visual field defect or vision loss(1.31%)and diplopia(0.86%).There were 2265 patients hospitalized within 3 days of 3433 acute stroke patients,including 801 patients admitted to hospital in 6 hours after the attack of stroke.The percentage of pre-hospital delay in acute stroke patients was above 65%.The result from generalized association rules showed the severe types in OCSP/TOAST classification,such as LAA(TOAST)and POCI(OCSP),were closely related to the inner fire and phlegm-dampness syndrome factors.And the mild types,such as LACI(OCSP)and SAA(TOAST),were related to the wind and yin-deficiency syndrome factors.The multivariate logistic regression analysis showed stroke history,poor per capita monthly income of family and the existence of transient hemianesthesia in 2 months before the onset,initial symptoms of headache were related to the long pre-hospital delay;at the same time,choosing emergency department firstly and the existence of facial/tongue paralysis or unconsciousness might indicate a shorter delay.Conclusions:1.The combination of stroke registry study and information technology could integrate data collection and input,which contribute to the development of the unified clinical and research information platform,then improve the data quality with the timeliness and authenticity,to support the process of large registry study.The standardization and coding of terms is not only the key of data structuralization,but also the core of machine language identification.2.The syndrome of mental disorder caused byphlegm-heat or phlegm-heat accumulation,which are consist of the fire and phlegm-dampness syndrome factors,could be related to the severe types of stroke,while wind and yin-deficiency could be related to the mild types of stroke.These discovery from association rules might help the exploration of the metabolomics characteristics of different syndrome factors by magnetic resonance spectrum in the future.3.The pre-hospital delay of stroke is still existed widely in China.Therefore,it is necessary to strengthen the propaganda and education on the common initial symptom,stroke recurrence and threatened apoplexy,to inform the public to present to the emergency department when the symptoms of stroke happened,and to enhance the consciousness of personal health.Meanwhile,paying more attention to the low-income population will reduce the pre-hospital delay when health policy made.