Impact of code stroke on thrombolytic therapy in patients with acute ischemic stroke at a secondary referral hospital in Taiwan

Hsiao, Cheng-Lun; Su, Yu-Chin; Yang, Fu-Yi; Liu, Chih-Yang; Chiang, Han‐Lin; Chen, Guei-Chiuan; Hsu, Po-Jen; Chen, Pei-Ya; Lin, Shinn-Kuang

doi:10.1016/j.jcma.2018.06.007

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…In the study of Huang et al in China, the mean CT scan time was 28 minutes, the mean time to rst visit patients according to Code 724 was 10 minutes, and the mean rTPA injection time was 116 minutes (34). In the study of Hsiao et al, the mean time to rst visit was 6 ± minutes, the mean patient arrival time to thrombolytic injection was 63 ± 23 minutes, and the mean time of arrival to brain imaging was 11 ± 7 minutes (35). Ayromlou et al in Tabriz, Iran, found the mean time of CT scan and patients' arrival to the hospital as 91 minutes, which was 66 minutes longer than the international guidelines.…”

Section: Discussionmentioning

confidence: 97%

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

Ghadimi

Hanifi

Dinmohammadi

2021

Preprint

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Background: The results of acute ischemic stroke (AIS) are highly affected by time-to-treatment. This study aimed at determining the factors influencing the in-hospital and pre-hospital delays in the complications and time-to-treatment in AIS. Methods: The present prospective study was carried out on 204 AIS patients referring to the stroke care unit in Zanjan, Iran (2019). To collected the required data, the patients and families were interviewed, as well as using the observations and records. The complication and mortality rates were recorded for 30 days after stroke via call follow-ups. Results: Based on the obtained results, the maximum delay was associated with the onset-to-arrival time (288.19 ±339.02 minutes). The logistic regression results indicated a statistically significant decline in the treatment via consultation after initiating the symptoms, transferring the patient to the hospital via emergency medical service, and the patients’ comprehension regarding the AIS symptoms. It was also found that an increase in the onset-to-treatment time (P <.001) and higher National Institutes of Health Stroke Scale (NIHSS) scores (P< .001) are the most critical factors related to the post-stroke complications. The higher age (P <.044) and NIHSS scores (P < .001) were considerably related to the mortality in AIS patients. Conclusion: It is essential to inform people regarding AIS indicators and referring to AIS treatment units to reduce the treatment time.

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Section: Discussionmentioning

confidence: 97%

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

Ghadimi

Hanifi

Dinmohammadi

2021

Preprint

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show abstract

“…Huang's et al study in China, the mean time to rst visit in code 724 patients was 10 minutes, the mean CT scan time was 28 minutes, and the mean rTPA injection time was 116 minutes (34). In the study of Hsiao et al, the mean time to rst visit was 6 ± 2 minutes, the mean time of arrival to brain imaging was 11 ± 7 minutes, and mean patient arrival time to thrombolytic injection was 63 ± 23 minutes (35). In the study of Ayromlou et al in Tabriz, Iran, the mean time of patients' arrival to the hospital and CT scan was 91 minutes, which was 66 minutes longer than the international guidelines, and the mean time of patients' arrival to the hospital and receiving rTPA was 147 minutes, 87 minutes longer compared to the international guidelines (20).…”

Section: Discussionmentioning

confidence: 97%

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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“…We did not compare the seasonal variations in CE stroke prevalence among different areas in Taiwan; for instance, in southern Taiwan (nearly 350 km away from the study location), the monthly change in mean temperature is narrow, ranging from 19.7 to 29.4 • C. Fourth, the rates of patients receiving IVT (6.5%) and EVT (2.5%) treatments in this study were relatively low. Through serial interventions for reducing in-hospital treatment delays and the continuous updating of applicable guidelines [40], the IVT rates at the index hospital have increased from 3.2% in 2011 to 14% in 2023. A formal EVT treatment program was launched at the index hospital in May 2017.…”

Section: Discussionmentioning

confidence: 99%

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke

Chen,

Chang,

Hsiao

et al. 2024

Biomedicines

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We investigated the seasonal variations in stroke in 4040 retrospectively enrolled patients with acute ischemic stroke (AIS) admitted between January 2011 and December 2022, particularly those with cardioembolic (CE) stroke, and compared predictors of unfavorable outcomes between AIS patients and CE stroke patients. The classification of stroke subtypes was based on the Trial of ORG 10172 in Acute Stroke Treatment. Stroke occurrence was stratified by seasons and weekdays or holidays. Of all AIS cases, 18% were of CE stroke. Of all five ischemic stroke subtypes, CE stroke patients were the oldest; received the most thrombolysis and thrombectomy; had the highest initial National Institutes of Stroke Scale (NIHSS) and discharge modified Rankin Scale (mRS) scores; and had the highest rate of in-hospital complications, unfavorable outcomes (mRS > 2), and mortality. The highest CE stroke prevalence was noted in patients aged ≥ 85 years (30.9%); moreover, CE stroke prevalence increased from 14.9% in summer to 23.0% in winter. The main predictors of death in patients with CE stroke were age > 86 years, heart rate > 79 beats/min, initial NIHSS score > 16, neutrophil-to-lymphocyte ratio (NLR) > 6.4, glucose > 159 mg/dL, cancer history, in-hospital complications, and neurological deterioration (ND). The three most dominant factors influencing death, noted in not only patients with AIS but also those with CE stroke, are high initial NIHSS score, ND, and high NLR. We selected the most significant factors to establish nomograms for predicting fatal outcomes. Effective heart rhythm monitoring, particularly in older patients and during winter, may help develop stroke prevention strategies and facilitate early AF detection.

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Impact of code stroke on thrombolytic therapy in patients with acute ischemic stroke at a secondary referral hospital in Taiwan

Abstract: Code stroke is effective in reducing in-hospital delays. The accuracy of code stroke activation has acceptable sensitivity but low specificity. Rapid patient assessment by neurologists increases the number of patients eligible for thrombolytic therapy.

Cited by 5 publications

References 30 publications

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

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

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke

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