Accuracy of First Recorded "Last Known Normal" Times of Stroke Code Patients.
Accuracy of First Recorded "Last Known Normal" Times of Stroke Code Patients.
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中风患者首次记录的“最后已知正常”时间的准确性。
DOI：
10.1016/j.jstrokecerebrovasdis.2015.04.041
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Karanjia,NavazP
中科院分区：
文献类型：
--
作者：
Spokoyny,Ilana;Raman,Rema;Ernstrom,Karin;Kim,AlexJ;Meyer,BrettC;Karanjia,NavazP
背景鉴于溶栓治疗的时间敏感性，准确记录最后已知的正常(LKN)时间对于确保中风患者的最佳治疗至关重要。本研究调查初步LKN时间(急诊科医生和急诊科医生)和修订LKN时间(神经内科/中风从业者)之间是否存在差异，以及这种差异可能对急性中风的紧急处理造成什么影响。方法收集加州大学圣地亚哥分校医院2008年10月至2013年7月所有具有治疗时间数据的卒中代码患者，根据初步LKN时间和修订LKN时间的差异进行分组：初步时间早于修订时间，相等2倍，初步时间晚于修订时间。我们比较了基线特征、卒中代码间期、重组组织型纤溶酶原激活剂(rt-PA)给药率、90天改良朗肯评分(MRS)、出院倾向和症状性脑出血。结果在261例患者中，73.6%的患者在初始和修订时间上存在差异：57.5%的患者初步LKN晚于修订，16.1%的初步LKN早于修订。基线特征、卒中编码速度、90天MRS评分、rt-PA给药率、出院倾向或症状性脑内出血发生率在两组之间没有显著差异。在接受rt-PA治疗的卒中患者中，如果使用了初步的LKN，29.4%的患者会不适当地保留rt-PA。在未接受rt-PA治疗的卒中患者中，初步治疗时间晚于修订时间的患者，如果使用初步时间，69.7%的患者可能会在相关的rt-PA治疗窗口之外接受不适当的治疗。如果将初步的LKN时间用于急性卒中决策，58%的患者可能会在批准的溶栓时间窗口之外接受治疗，不良事件的风险更高，16%的患者可能被不适当地排除在溶栓治疗之外。这项研究强调了培训的必要性，尤其是在没有中风专业知识的医院，需要确定和完善中风的实际发病时间。
BackgroundGiven the time sensitivity of thrombolytic therapy, the accurate documentation of last known normal (LKN) time is crucial to ensure optimal management of stroke patients. This study investigates whether a difference exists between preliminary LKN times (first responders and emergency department practitioners) and revised LKN times (neurology/stroke practitioners), and what potential impact on emergent management of acute stroke this discrepancy may pose.MethodsAll stroke code patients from UC San Diego hospitals from October 2008 to July 2013 with treatment time data were included and grouped based on the disparity between preliminary LKN time and revised LKN time: preliminary earlier than revised, 2 times equal, and preliminary later than revised. We compared baseline characteristics, stroke code intervals, rates of recombinant tissue plasminogen activator (rt-PA) administration, 90-day modified Rankin Scale (mRS) score, discharge disposition, and symptomatic intracerebral hemorrhage.ResultsOf 261 patients, 73.6% had disparity between preliminary and revised times: 57.5% had later preliminary LKN than revised, and 16.1% had earlier preliminary LKN than revised. Baseline characteristics, stroke code speed, 90-day mRS score, rates of rt-PA administration, discharge disposition, or rates of symptomatic intracerebral hemorrhage were not significantly different between the groups. Among rt-PA-treated stroke patients whose preliminary time was earlier than the revised time, had the preliminary LKN been used, 29.4% would have had rt-PA withheld inappropriately. In those stroke patients excluded from rt-PA treatment for being outside the treatment window, whose preliminary time was later than the revised time, had the preliminary time been used, 69.7% would have been inappropriately treated outside the relevant rt-PA window.ConclusionsMost patients had disparity between preliminary and revised LKN times. Had the preliminary LKN time been used for acute stroke decision-making, 58% of patients would have potentially been treated outside the approved thrombolytic time window, with higher risk of adverse events, and 16% may have been inappropriately excluded from thrombolysis. This study highlights the need for training in the determination and refinement of the actual time of stroke onset, especially at hospitals without stroke expertise.
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