Delays in door-to-needle time for acute ischemic stroke in the emergency department: A comprehensive stroke center experience
Delays in door-to-needle time for acute ischemic stroke in the emergency department: A comprehensive stroke center experience
复制标题
DOI：
10.1016/j.jns.2017.03.003
复制
发表时间：
2017-05-15
影响因子：
4.4
通讯作者：
Sawyer, Robert N.
中科院分区：
文献类型：
--
作者：
Mowla, Ashkan;Doyle, Jordan;Sawyer, Robert N.
背景资料：目前美国卒中协会指南建议在患者到达后60分钟内开始静脉溶栓（IVT）治疗急性缺血性卒中（AIS），因为IVT治疗AIS的获益具有时间依赖性。本研究旨在确定纽约州最大的综合性卒中中心之一的急诊科的门到针时间（DTN）的延迟因素。我们还建议采取措施，以减少delays.Methods：我们回顾性审查了所有AIS患者的病历谁收到IVT在我们的急诊科患者在2012年4月1日至2015年12月31日，以确定那些DTN时间> 60分钟。对于每组，我们建议采取措施，以减少治疗delays.Results：共487例患者接受IVT AIS在3.7年的时间。其中，96例患者（20.4%）符合我们的DTN时间延迟标准。延迟获得中风成像和高血压控制是最常见的因素。38例患者（39.5%）延迟获得基于CT的卒中成像。22例患者（22.9%）在IVT前需要控制血压升高。DTN时间延迟的其他原因包括卒中分诊和寻呼延迟波动性神经症状（72%），诊断不确定（12.5%），与获得同意相关的延迟（93%），以及症状发作时间的不确定性（5.2%）。结论：在我们综合卒中中心的病历回顾中，确定了AIS IVT延迟的重要和常见原因。作者推荐的策略是针对每种延迟因素类别实现更快的DTN时间，包括更快的卒中成像采集和解释，更有效的分诊方案和更快的符合IVT条件的AIS患者的血压控制。(C)2017爱思唯尔B.V.保留所有权利。
Background: Current American Stroke Association guidelines recommend initiating intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) within 60 min of patient arrival, given the benefits of IVT for AIS are time dependent. This study aimed to identify the delaying factors in door-to-needle time (DTN) in the emergency department of one of the largest comprehensive stroke centers in New York State. We also recommended measures to reduce the delays.Methods: We retrospectively reviewed the medical charts of all AIS patients who received IVT in our emergency department patients between April 1, 2012 and December 31, 2015 to identify those with a DTN time of > 60 min. We categorized the factors causing the delay into different groups. For each group, we recommended measures to reduce the treatment delays.Results: A total of 487 patients received IVT for AIS during the 3.7-year period. Of these, 96 patients (20.4%) met our DTN time delay criteria. Delays for obtaining stroke imaging and hypertension control were the most common factors. Thirty eight patients (39.5%) had delay in obtaining CT-based stroke imaging. Twenty-two patients (22.9%) required control of elevated blood pressure prior to IVT. Other causes for delay in DTN time included delay in stroke triage and paging (11.4%), fluctuating neurological symptoms (72%), uncertainty about diagnosis (12.5%), delays associated with obtaining consent (93%), and uncertainty about the time of symptom onset (5.2%).Conclusion: Important and common causes of delay in IVT for AIS were identified in a review of charts at our comprehensive stroke center. The authors recommend strategies to achieve faster DTN time for each of the delaying factor categories including faster acquisition and interpretation of stroke imaging, more effective triage protocols and faster blood pressure control for AIS patients who are eligible for IVT. (C) 2017 Elsevier B.V. All rights reserved.