Assessment of the application of clinical pathways for cerebral infarction in patients aged 75 years and above / 中华老年医学杂志

ABSTRACT

Objective To evaluate the safety and therapeutic efficacy of clinical pathways(CP) for cerebral infarction in patients aged 75 years and above.Methods A cohort of 363 cerebral infarction patients aged 75 years and above after excluding clinical variants were recruited from January 2016 to June 2018 at the neurology department of Nanyang City Center Hospital.Patients were randomly divided into the CP group(n=184)and the control group(n=179).The day-90 modified Rankin scale score(mRS),mortality,incidences of complications,length of hospital stay,total hospital costs and drug costs were compared between the two groups.Results The proportion of patients with mRS 0-1 was higher in the CP group than in the control group(77.2％ or 142/184 vs.55.3％ or 99/179,x2=19.443,P =0.000).The incidences of pulmonary infection(23.9％,44/184)and deep venous thrombosis(14.7 ％,27/184)were lower in the CP group than in the control group(42.5 ％,76/179 & 29.1％,52/179;x2 =14.101,11.014,P=0.000,0.001).There was a significant difference in mortality between the two groups[4.9％ (9/184)vs.11.2％ (20/179),x2 =4.871,P =0.027].There was no significant difference in the other incidences of complications between the groups(P ＞ 0.05).Hospital stay length (18.3 ± 2.9) d,total cost (2.72 ± 0.42) × 104 yuan,and drug cost (0.87±0.29)× 104yuan in the clinical pathway group were lower than those in the control group [(22.8±4.4)d,(3.55±0.81) × 104 yuan,(1.42±0.29) × 104 yuan](t =11.546,12.168 and 18.335,all P =0.000).Conclusions The adoption of clinical pathways can improve medical quality,shorten hospitalization days and reduce hospitalization costs and medical costs in elderly patients with cerebral infarction.