In‐hospital systems interventions in acute stroke reperfusion therapy: a meta‐analysis

Abstract

Objectives The value of in‐hospital systems‐based interventions in streamlining treatment delays associated with reperfusion therapy delivery in acute ischaemic stroke (AIS), in the emergency department (ED), is poorly understood. This systematic review and meta‐analysis aimed to assess and quantify the value of in‐hospital systems‐based interventions in streamlining reperfusion therapy delivery following AIS. Material & Methods Articles from the following databases were retrieved: Medline, Embase and Cochrane Central Register of Controlled Trials. The primary endpoint was in‐hospital time metrics between the intervention and control group. The secondary endpoint included the rate of good functional outcome at 90 days. Results 393 Systems intervention studies published after 2015 were screened, and 231 full articles were then read. In total, 35 studies with 35,815 patients were included in the final systematic review and 26 studies with 7,089 patients were used in the meta‐analysis. The greatest time reductions from in‐hospital system interventions were achieved in door‐to‐needle (DTN) time (SMD: −2.696, 95% CI: −2.976, −2.416, z = 3.03, p = 0.002). Systems interventions were also associated with a statistically significant improvement in mortality (RR: 0.25, 95% CI: 0.18, 0.38), rate of symptomatic intracerebral haemorrhage (RR: 0.07, 95% CI: 0.04, 0.1) and ≤60‐minute reperfusion rates (RR: 0.63, 95% CI: 0.51, 0.79). Conclusions The use of in‐hospital workflow optimization is imperative to expedite reperfusion therapy delivery and improving patient outcomes. To reduce the morbidity and mortality of stroke globally, in‐hospital workflow guidelines should be adhered to and incorporated including the optimal elements identified in this study.

Reasons and predictors of non‐thrombolysis in patients with acute ischemic stroke admitted within 4.5 h

“…It is important to initiate all measures that can reduce the time-delay both pre-and intrahospital. 15,41,42 This can be achieved by improving the public awareness of stroke, close cooperation between the EMS and the hospital and treatment of acute stroke patients according to continuously revised protocols and guidelines.…”

Impact of diabetes on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: A meta-analysis

“…26,27 On a systemic level, this warrants establishing specialized pathways to identify AIS patients with a high risk of poor outcomes. 9,28 Current evidence on functional outcome at 90 days for patients with diabetes who have undergone reperfusion therapy is mixed. 5,26,[29][30][31] Most of the studies included in this meta-analysis did not individually find a significant relationship between diabetes and the odds of poor functional outcome.…”

Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review

“… 9 Additionally, other factors, including patient-associated socioeconomic variables and health system parameters, also impact access to acute care services and postreperfusion therapy outcomes in AIS. 29 - 34 …”