Identification of Rate-Limiting Steps in the Provision of Thrombolytics for Acute Ischemic Stroke

Metts, Elise L.; Bailey, Abby M.; Weant, Kyle A.; Justice, Stephanie Baker

doi:10.1177/0897190016674408

Cited by 5 publications

(10 citation statements)

References 14 publications

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“…The analysis was carried out for the remaining 379 patients, 180 with PHN and 199 without PHN (Figure 1). Median door-to-CT time for the PHN group was 6 min less than for the no-PHN group, which was statistically significant (median [interquartile range: IQR]; 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs 20 ; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows baseline characteristics of patients treated with IV recombinant tissue plasminogen activator (r-TPA) associated with PHN. Among patients treated with IVT, the median door-to-CT and door-to-needle time was significantly lower for the PHN group compared with those in the no-PHN group (median [IQR]; 15 [10][11][12][13][14][15][16][17][18][19][20][21][22] This study also evaluated the accuracy of code activation by EMS technicians. The EMS technicians were instructed based on the protocol to notify dispatch if they were visiting a patient who met the Cincinnati stroke future science group www.futuremedicine.com Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Multiple factors have been identified for in-hospital delays including decision making process, laboratory tests, neurology service arrival and imaging [10][11][12]. Previously, we tried to identify and resolve the issues related to in-hospital latencies in our hospital in Tabriz, Iran.…”

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confidence: 99%

“…These can be divided into 'out of hospital' and 'in-hospital' delays and since decades ago, lots of studies have been conducted to evaluate such delays and therefore improving the outcome of stroke. Review of these studies shows that over time there has been a steady reduction in such time intervals [10].…”

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confidence: 99%

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Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

et al. 2018

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Aim:To reduce in-hospital intervals by developing a prehospital notification (PHN) protocol which directly notifies a neurologist to prepare for possible treatment. Methods: A 24/7 connection was established between emergency medical services dispatch and the on-call neurologist. A database of all patients with in-hospital stroke code activation was developed, door-to-computed tomography (CT) time and door-toneedle time was recorded from January 2013 to December 2016. The statistical results were considered significant at p < 0.05. Result: PHN resulted in a significant reduction in door-to-CT time (median 14 vs 20; p < 0.001). Among patients who were treated with intravenous thrombolysis, door-to-needle time was significantly shorter in patients with PHN compared with non-PHN group (median 42 vs 70; p < 0.001). Conclusion: PHN effectively reduced door-to-CT and door-to-needle times.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

et al. 2018

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“…Various factors, including pre-hospital and intra-hospital causes, may delay the time-totreatment in AIS patients. Delays in identifying patients and delays in patient transfers are considered as the pre-hospital causes while delays in neurologic visits, delays in brain imaging, delays in decisionmaking in the treatment process are identi ed as intra-hospital delays cause in this regard (17,18). In a study in Iran, 80.2% of patients did not receive rTPA due to a delay of over 4 hour and 30 minutes.…”

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confidence: 99%

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

Ghadimi¹,

Hanifi²,

Dinmohammadi³

2020

Preprint

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Background: Time-to-treatment affects the outcomes of acute ischemic stroke (AIS). The aim of this study was to determine the factors affecting pre-hospital and in-hospital delays in the time-to-treatment and complication in AIS. Methods: This prospective study was performed on 204 AIS patients referred to the stroke care unit in Iran (Zanjan) in 2019. Data were completed by interviewing the patients, their families, records, and observations. The mortality and complication rates were recorded for 30 post-stroke days through call follow-up. Results: The results showed that the highest delay was related to the onset-to-arrival time (288.19 ±339.02 minutes). Results of logistic regression showed that treatment delay declined significantly by consulting followed by symptoms onset, patient transfer through emergency medical service to the hospital, and patients’ understanding of AIS symptoms. The results also showed that increasing the onset-to-treatment time (P< .001) and high National Institutes of Health Stroke Scale (NIHSS) score (P< .000) were the most important factors associated with post-stroke complications. High age (P< .044) and high NIHSS scores (P< .001) were significantly associated with mortality in patients with AIS. Conclusion: Informing people about AIS symptoms and referring to AIS treatment units are essential in reducing the treatment time.

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

et al. 2022

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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.

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Identification of Rate-Limiting Steps in the Provision of Thrombolytics for Acute Ischemic Stroke

Cited by 5 publications

References 14 publications

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

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

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