Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians

Annals of Emergency Medicine
Iiro HeikkiläAri Palomäki

Abstract

Thrombolysis with tissue plasminogen activator should occur promptly after ischemic stroke onset. Various strategies have attempted to improve door-to-needle time. Our objective is to evaluate a strategy that uses an emergency physician-based protocol when no stroke neurologist is available. This was a retrospective before-after intervention analysis in an urban hospital. Reorganization of the acute ischemic stroke treatment process was carried out in 2013. We evaluated time delay, symptomatic intracerebral hemorrhage, and clinical recovery of patients before and after the reorganization. We used multivariable linear regression to estimate the change in door-to-needle time before and after the reorganization. A total of 107 patients with comparable data were treated with tissue plasminogen activator in 2009 to 2012 (group 1) and 46 patients were treated during 12 months in 2013 to 2014 (group 2). Median door-to-needle time was 54 minutes before the reorganization and 20 minutes after it (statistical estimate of difference 32 minutes; 95% confidence interval 26 to 38 minutes). After adjusting for several potential cofounders in multivariable regression analysis, the only factor contributing to a significant reduction in delay wa...Continue Reading

Citations

Jul 1, 2021·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Martin MöckelBarbra Backus
Aug 18, 2021·Journal of Medical Case Reports·Markku Grönroos, Ari Palomäki

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