Impact of prehospital stroke code in a public center in Paraguay: A pilot study

Abstract

Prehospital stroke code activation results in reduced pre- and in-hospital delays and triage and transport of stroke patients to the right centers. In Paraguay, data about acute reper fusion treatment are not available. Recently, a pilot prehospital stroke code program was implemented in the country in November 2016. In an observational, single-center cohort study with a before–after design, from April 2015 to July 2018, we found that 193/832 (23.1%) of stroke patients were stroke code activated, and from these, 54 (6.5%) were brought to hospital under the prehospital stroke code protocol. Fifty-eight patients (58 alteplase and 2 additional endovascular treatment) received reperfusion therapy. Prehospital stroke code patients had a lower mean door-to-CT time (24 vs. 33 min, p = 0.021) and lower mean door-to-needle time (35.3 vs.76.3 min, p < 0.001) compared to in-hospital stroke code patients. Prehospital stroke code is feasible in Paraguay and has a positive impact on in-hospital acute stroke management, reducing delays and increasing the rates of reperfusion treatments.

Improving Thrombolysis for Acute Ischemic Stroke: The Implementation and Evaluation of a Theory-Based Resource Integration Project in China

“…Acute stroke treatment resources in developing countries are largely unevenly distributed and lack of cooperation [34]. Thus the integration of resources, especially operant resources such as information and knowledge, has to overcome serious barriers from infrastructure to social institutions [36,37]. For example, an AIS patient in China might experience serious treatment delays due to the time-consuming pretreatment medical insurance certification or just because the accompanying family could not understand the benefits of intravenous thrombolysis [38].…”

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

“…This time is closely related to the structural and operational reorganization to provide adequate and timely care to affected cases in the stroke care units, and can also be reduced if an adequate diagnostic hypothesis is raised for stroke cases by the prehospital urgency and emergency medical services, 40 45 50 54 with the intention of quickly activating the stroke code. 46 50 55…”

“…This time is closely related to the structural and operational reorganization to provide adequate and timely care to affected cases in the stroke care units, and can also be reduced if an adequate diagnostic hypothesis is raised for stroke cases by the prehospital urgency and emergency medical services, 40,45,50,54 with the intention of quickly activating the stroke code. 46,50,55 The symptoms-onset-to-needle time decreased in 63.2% of the studies after implementing the protocol. 12,21,23,24,29,[36][37][38][39][40]42,46 Thus, despite the advances in in-hospital care, efforts are required to raise awareness and sensitize people in the community regarding recognition of the urgency of attending a case with signs and symptoms compatible with stroke.…”