Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

Sablot, Denis; Ion, Ioana; Khlifa, Khaled; Farouil, Geoffroy; Leibinger, Franck; Gaillard, Nicolas; Laverdure, Alexandre; Bensalah, Zoubir Mourad; Mas, Julie; Fadat, Bénédicte; Smadja, Philippe; Ferraro-Allou, Adélaïde; Bonnec, Jean-Marie; Olivier, Nadège; Dutray, A.; Tardieu, Maxime; Dumitrana, Adrian; Guibal, Aymeric; Jurici, Snejana; Bertrand, J. L.; Allou, Thibaut; Arquizan, Caroline; Bonafé, Alain

doi:10.1159/000489568

Cited by 14 publications

(5 citation statements)

References 33 publications

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“…Despite the challenges of using MRI to triage acute stroke patients, there is a growing movement to expand its use. It is possible to meet the time metrics specified in the AHA guidelines 99,100 because MRI can exclude stroke mimics, thereby avoiding unnecessary and inappropriate administration of thrombolysis, which is costly and can be harmful. MRI is currently used to triage patients who present in an unknown window 37,101 .…”

Section: Discussionmentioning

confidence: 99%

Amide proton transfer imaging in stroke

et al. 2022

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Amide proton transfer (APT) imaging, a variant of chemical exchange saturation transfer MRI, has shown promise in detecting ischemic tissue acidosis following impaired aerobic metabolism in animal models and in human stroke patients due to the sensitivity of the amide proton exchange rate to changes in pH within the physiological range. Recent studies have demonstrated the possibility of using APT-MRI to detect acidosis of the ischemic penumbra, enabling the assessment of stroke severity and risk of progression, monitoring of treatment progress, and prognostication of clinical outcome. This paper reviews current APT imaging methods actively used in ischemic stroke research and explores the clinical aspects of ischemic stroke and future applications for these methods.

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Section: Discussionmentioning

confidence: 99%

Amide proton transfer imaging in stroke

et al. 2022

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“…We found 49 studies containing information on intra-hospitalar organizational factors associated with delays or access to ART ( Appendix A - Table A3 ). Training emergency room professionals [ 61 , 62 , 63 , 64 , 65 , 66 ], promotion of specific stroke code protocols [ 30 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], direct transfer from ambulance to the imaging room [ 86 , 87 , 88 , 89 , 90 , 91 , 92 ], strategic location of the imaging room (IR) [ 93 ], and routine administration of thrombolysis in the IR, were considered effective strategies to reduce thrombolysis delay [ 68 , 69 , 85 , 86 , 87 , 88 , 89 , 94 , 95 ]. In places where the physician, usually a neurologist, responsible for thrombolysis, is on-call, pre-notification of possible stroke before imaging also reduced delays [ 37 , 68 , …”

Section: Resultsmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

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“…The team performed several interventions, including clarification of individual roles, enhancement of material availability for the stroke code team, and development of new protocols that visually summarized how physicians and nurses should collaboratively work during stroke codes. Since such methods often require the investment of substantial resources, such as time, financial resources, and human resources [ 6 ], they are only implemented in medical facilities that can incur their implementation costs [ 12 , 13 ]. This study aimed to propose a novel, simple, and low-cost method to reduce the DTC time and to assess the validity of providing feedback regarding each patient's DTC time to a small group of medical workers and physicians through field experiments.…”

Section: Introductionmentioning

confidence: 99%

Low-Cost Feedback Program for Reducing the Door-to-Computed Tomography Time

Mitsuhashi

Tokugawa

Mitsuhashi

2022

Cerebrovasc Dis Extra

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Introduction: Early restoration of blood flow in stroke patients can be achieved by reducing the door-to-computed tomography (DTC) time. Previous research has proposed several methods to reduce the DTC time, but the implementation costs limit its transferability. This study aimed to propose a novel, simple, and low-cost method for reducing the DTC time by providing feedback on each patient’s DTC time to a small group of medical workers and physicians. Methods: A field experiment was conducted for 233 days, and the DTC time of 249 patients with stroke symptoms who were transported via ambulance to a medium-sized university hospital in Japan within 24 h after stroke onset was obtained. The first and second feedback reports on the 59th day and 154th day, respectively, were provided at the beginning of the field experiment. Using the data collected during the first 58 days as baseline data, the baseline data were compared with the post-intervention data. As part of the intervention, feedback on the DTC time for each patient was provided to six medical workers and physicians during regular meetings. The primary outcome was a continuous measure of DTC time (in min). The feedback effect hypothesis was formulated prior to data collection. Results: In a sample of 68 patients at baseline, the mean DTC time was 18.16 min with a standard deviation of 7.38 min. As a result of the two feedback reports, in the sample with outliers, the mean and standard deviation decreased to 15.64 min and 5.97 min, respectively. The difference in means was 2.51 min (p = 0.021 in t tests). Results of the test of the equality of the standard deviations suggested that the two standard deviations were not equal (p = 0.065). Conclusions: The low-cost interventions successfully reduced both the mean DTC time and variation, suggesting an improvement in the quality and consistency of medical services. The result of our fine-grained analysis with a field-experiment design supports the role of feedback in achieving early treatment as suggested in the Target: Stroke initiative.

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Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

Cited by 14 publications

References 33 publications

Amide proton transfer imaging in stroke

Amide proton transfer imaging in stroke

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Low-Cost Feedback Program for Reducing the Door-to-Computed Tomography Time

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