The Study On Influence Factors Of Admission Delay In Ischemic Stroke Patients, Adverse Outcome And It’s Nursing Strategy

Objectives:To assess the status of admission delay of ischemic stroke patients. To explore the influencefactors of admission delay in patients with ischemic stroke. Analysis of admission delay in ischemic strokepatients caused by adverse outcomes. To provide scientific theoretical basis for clinical make nursingintervention measures.Object and Methods:Adopt the survey follow-up study, selected273cases hospitalized patients with ischemic strokefrom July2011to December2011in one grade A class3hospital neurology clinic, investigated admissiondelay status and related influencing factors, and investigated the adverse outcomes after one year. The datawas collected by questionnaire, investigation of the content mainly including the following several part:(1)the patient’s general demography information: including age, sex, place of residence, marital status, level ofeducation, living pattern, type of work, type of medical insurance.(2) stroke-related risk factors score:including blood pressure, blood cholesterol, diabetes, smoking, heart disease, weight, physical exercise,family history. The stroke-related risk factors score used the “acute cerebrovascular disease risk score card”recommended by National Stroke Association.(3)The onset situation of stroke: time since stroke onset,location of onset, whether have bystander onset, Whether referral, admission time, whether worried aboutmedical treatment fees when they decided to go to hospital and soon.(4)stroke-related knowledge cognitionscore: from stroke basic knowledge cognition score, stroke-related risk factors cognition score and strokeprevention knowledge three aspects.(5)Patients with nerve function damage degree:using NIHSS (NationalInstitutes of Health Stroke Scale) respectively to evaluation nerve function damage degree of patients afteradmission.(6)The occurrence of adverse outcomes included: patients survival, recurrence of the conditionand readmission status.Using the software of EpiData3.1entry the data and SPSS13.0analyse the data, single factoranalysis using t test, non-parametric test and x2, multivariate analysis using Logistic regression analysis, inwhich the level of the test was=0.05and P values were two-tail probability. Results:1. A total of273patients with ischemic stroke fulfilled the selection criteria, the patients agreedto conduct questionnaire investigation. The male152cases (55.7%), female121cases (44.3%), mean agewas62years (SD12) old. For the rural residence of the84patients (30.8%), city189cases (69.2%); Livingpattern: living with their children114cases (41.7%), living with their spouse137cases (50.2%), and livingalone22cases (8.1%); Marital status: unmarried3patients (1.1%), married228cases (83.5%), divorced1cases (0.4%), widowed41cases (15.0%); Education degree: junior high school the following188cases(68.9%), high school to college75cases (27.4%), college or above10cases (3.7%);273cases of ischemicstroke patients with the average time of admission was40.91±4.12h, ninety-eight patients (35.9%) wereadmitted at the hospital within4.5h and110patients (40.3%) within6h, admission time>6h with163patients (59.7%), admission delay rate of59.7%.2. Admission time≦6h group and admission time>6h group in the patient’s residence(P<0.001),education degree (P=0.017), labor type (P=0.001), medical insurance type (P=0.019), time ofonset of symptoms (P=0.007), whether referral (P<0.001),whether afraid of high cost oftreatment(P<0.001), whether have medical examination experience(P=0.009), stroke-related knowledgecognition score (P<0.001),differences have statistical significance, P<0.05.3. Binary logistic analysis showed that the factors influencing admission delay were: referredfrom another hospital (P<0.001, OR=22.364), low patients’ stroke-related knowledge cognition score(P=0.002, OR=0.904) and lived with their spouse (P=0.042, OR=2.135).4. After one year follow-up study for the discharged patients, found that admission time≦6hgroup and admission time>6h group had statistical significance in the difference in whether readmissions(x~2=4.465, P=0.044).Conclusion:1. Ischemic stroke patients with a mean admission time long, within6h admission rate lower,admission delay phenomenon seriously.2. Referred from another hospital, low patients’ stroke-related knowledge cognition score andliving with their spouse are the main factors of admission delay.3. Ischemic stroke patients admission delay will increase patients after discharge from hospital readmission possibility, influence the recovery of patients after discharge.