Thrombolysis Experience in Costa Rica Compared Against Individual Patient Data from two Randomized Controlled Trials

Torrealba‐Acosta, Gabriel; Barboza-Elizondo, Miguel; Fernández-Morales, Huberth; Qasim, Muhammad; Litvak, Paul; Rothlisberger, Travis; Tsivgoulis, Georgios; Alexandrov, Andrei V.; Kent, Thomas A.

doi:10.1016/j.jstrokecerebrovasdis.2022.106599

Cited by 2 publications

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References 23 publications

(35 reference statements)

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“…For each category of primary diagnosis, we performed Euclidean matching of nearest neighbours in terms of a two-dimension space distance of age and SOFA score 30 31. A linear sum assignment problem (LSAP) algorithm, also known as Munkres algorithm,32 was employed as it gives consistently lower overall distances between matched pairs.…”

Section: Methodsmentioning

confidence: 99%

Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study

Escamilla-Ocañas

Torrealba‐Acosta²,

Qasim³

et al. 2022

BMJ Open Qual

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Background and objectivesStructured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU) and assessed its effect on patient outcomes.Design/methodsThis quality improvement project followed a Plan–Do–Study–Act (PDSA) methodology. A checklist for medication reconciliation, thromboembolic prophylaxis, glycaemic control, daily spontaneous awakening, breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation was implemented during daily patient rounds. Main outcomes included the rate of new infections, mortality and NCCU-length of stay (LOS). Intervened patients were compared with historical controls after propensity score and Euclidean distance matching to balance baseline covariates.ResultsAfter several PDSA iterations, we applied checklists to 411 patients; the overall average age was 61.34 (17.39). The main reason for admission included tumour resection (31.39%), ischaemic stroke (26.76%) and intracerebral haemorrhage (10.95%); the mean Sequential Organ Failure Assessment (SOFA) score was 2.58 (2.68). At the end of the study, the checklist compliance rate throughout the full NCCU stays reached 97.11%. After controlling for SOFA score, age, sex and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with a reduced LOS (ß=−0.15, 95% CI −0.24 to −0.06), reduced rate of any new infections (OR 0.59, 95% CI 0.40 to 0.87) and reduced urinary tract infections (UTIs) (OR 0.23, 95% CI 0.09 to 0.55). Propensity score and Euclidean distance matching yielded 382 and 338 pairs with excellent covariate balance. After matching, outcomes remained significant.DiscussionThe implementation of safety checklists in the NCCU proved feasible, easy to incorporate into the NCCU workflow, and a helpful tool to improve adherence to practice guidelines and quality of care measurements. Furthermore, our intervention resulted in a reduced NCCU-LOS, rate of new infections and rate of UTIs compared with propensity score and Euclidean distance matched historical controls.

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Section: Methodsmentioning

confidence: 99%

Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study

Escamilla-Ocañas

Torrealba‐Acosta²,

Qasim³

et al. 2022

BMJ Open Qual

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“…11, 15, 18, 20, 21 A short-term (7-10 days) outcome model for stroke was previously published and placed in the public domain to serve a similar purpose. 22…”

Section: Introductionmentioning

confidence: 99%

Predictive outcome models in ischemic stroke: Comparison of Latin American Stroke Registry and RESILIENT against models

Torrealba‐Acosta

Barboza

Araúz

et al. 2023

Preprint

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Introduction: Despite the significant stroke burden in the region, the RESILIENT trial remains the only randomized controlled trial (RCT) for stroke treatment in Latin America. Imbalances in baseline factors typically hamper comparisons between stroke populations. The Latin American Stroke Registry (LASE) is a registry of patients receiving tPA and thrombectomy from 17 centers across 9 countries. We compared the outcomes of LASE and RESILIENT at each cohorts baseline characteristics against models derived from other RCTs. <break><break>Methods: A systematic search identified RCTs that provided median NIHSS, mean age, percentage of patients receiving tPA, time-to-randomization, 90-day mRS0-2, and mortality. Akaike Information Criterion (AIC) was used to select the best model amongst 31 combinations of 5 variables. 90-day outcomes of LASE and RESILIENT were compared at their baseline values against the selected model. <break><break>Results: 35 RCTs encompassing 8376 subjects were identified. Models based on baseline NIHSS and the percentage of intravenous thrombolysis (IVT) were considered the most optimum in terms of AIC. The LASE registry included 950 patients receiving IVT alone, 127 that received IVT and mechanical thrombectomy (MT), and 101 receiving only MT. LASE & RESILIENT outcomes were plotted onto the models at their baseline values. LASE IVT alone group outcomes were in line with the RCT-informed model. LASE MT alone and MT + IVT, and the RESILIENT MT arm (68.5% IVT) demonstrated superior efficacy compared to no-MT. The RESILIENT control arm (71.8% tPA) had higher-than-expected mortality, while mortality of all other arms was within the predicted range. <break><break>Conclusion: <break>Functional outcomes and mortality of patients from the LASE and RESILIENT trial receiving MT and MT+IVT compared favorably to the 90-day functional and mortality outcomes predicted in a model derived from no-MT data from other stroke RCTs, indicating Latin American MT systems of care are comparable to those of more resourceful regions. Higher mortality from IVT in the RESILIENT trial requires further investigation.

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Thrombolysis Experience in Costa Rica Compared Against Individual Patient Data from two Randomized Controlled Trials

Cited by 2 publications

References 23 publications

Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study

Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study

Predictive outcome models in ischemic stroke: Comparison of Latin American Stroke Registry and RESILIENT against models

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