Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

Abstract

Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

Emergency and Urgent Care Network: Analysis of the Stroke Care Line According to Care Times and Outcomes

“…There was no significant reduction regarding the length of stay, corroborating results from a literature review [12], which show that the length of stay is linked to the patient's health status and/or their pre-existing conditions, as well as complications that may occur during treatment.…”

“…A literature review identified the importance and relevance of implementing protocols in stroke care and their effectiveness in reducing the time elapsed between the onset of symptoms and the start of treatment [12], as well as increasing the performance of reperfusion therapies and improving prognosis after discharge [13].…”

Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil

“…A decade later, Rocha et al demonstrated that Brazilian SU care, while not impacting LOS, correlated with reduced in-hospital and 30-day mortality rates compared to GW care [21]. A recent systematic review analyzed the effectiveness of implementing AIS protocols in reducing care time, encompassing primary studies published between 2011 and 2020 [22]. Notably, among the included studies, none involved Brazilian patients.…”

Rede de atenção às urgências e emergências: impacto da implantação da linha de cuidado ao acidente vascular cerebral

“…Esse tempo diminuiu ainda mais após tal período, indicando os efeitos da reorganização dos fluxos dentro da instituição, tornando mais rápido o início do tratamento e atingindo as metas propostas. Isto mostra que, de fato, há uma maior necessidade de o município investir em ações para a redução do tempo do APH com a intenção de aumentar a quantidade de pessoas elegíveis para o recebimento de tratamento trombolítico.Quanto ao tempo de internação, não se identificou redução significativa, corroborando com resultados de uma revisão da literatura(LEITE et al, 2022) que mostrou que em apenas dois de 30 artigos analisados houve diminuição em tal tempo. Ou seja, é possível refletir que talvez que o tempo de internação esteja atrelado ao estado de saúde da vítima e/ou suas condições pré-existentes, bem como às complicações que podem ocorrer durante o tratamento.Quanto aos desfechos dos casos de AVC isquêmico do estudo submetidos à trombólise, identificou-se que a proporção de ocorrências desfavoráveis aumentou em consonância com o aumento da gravidade dos casos, assim como no estudo NINDS (1995), em que as vítimas com escore NIHSS >20 tiveram 17% de chance de sangramento intracraniano.…”