Are All Stroke Patients Eligible for Fast Alteplase Treatment? An Analysis of Unavoidable Delays

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Philip M C ChoiEric E Smith

Abstract

The National Quality Forum recently endorsed a performance measure for time to intravenous thrombolytic therapy which allows exclusions for circumstances in which fast alteplase treatment may not be possible. However, the frequency and impact of unavoidable patient reasons for long door-to-needle time (DNT), such as need for medical stabilization, are largely unknown in clinical practice. As part of the Hurry Acute Stroke Treatment and Evaluation-2 (HASTE-2) project, we sought to identify patient and systems reasons associated with longer DNT. From June 2012 to June 2013 we collected data on DNT and potential reasons for delays from 102 consecutive patients presenting directly to the emergency department who were treated with alteplase within 4.5 hours of symptom onset. Mean age was 71 years, 56/113 (54%) were women, median NIH Stroke Scale score was 13, and median DNT was 53 minutes. Potential delays were noted in 59/102 (58%), of which 31/102 (31%) were unavoidable patient-related or eligibility reasons. Median DNT was longer when patient-related or eligibility reasons for delay were present (60 minutes) than when absent (45 minutes, p = 0.005). Multivariable modeling showed that need for urgent medical stabilization, present...Continue Reading

References

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Citations

Nov 16, 2017·International Journal of Stroke : Official Journal of the International Stroke Society·Noreen KamalMichael D Hill
Feb 15, 2017·Stroke; a Journal of Cerebral Circulation·Jessalyn K HolodinskyMayank Goyal
Aug 30, 2019·Stroke; a Journal of Cerebral Circulation·Philip M C ChoiHelen M Dewey
Feb 3, 2021·International Journal of Stroke : Official Journal of the International Stroke Society·Stanley H HungAmy Brodtmann
Feb 24, 2017·Stroke; a Journal of Cerebral Circulation·Noreen KamalEric E Smith
Nov 18, 2021·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Rosalie McDonoughMayank Goyal

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