Delayed Intravenous Thrombolysis in Patients with Minor Stroke

Autor: Jinkwon Kim, Sung Il Sohn, Hyo Suk Nam, Jaseong Koo, Kyoungsub Kim, Kijeong Lee, Joonsang Yoo, Young Dae Kim, Seong Hwan Ahn, Ji Hoe Heo, Jaehyuk Kwak, Jeong-Ho Hong, Jang Hyun Baek
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Neurology
medicine.medical_treatment
Severity of Illness Index
Tissue plasminogen activator
Drug Administration Schedule
Time-to-Treatment
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Interquartile range
0502 economics and business
medicine
Humans
Thrombolytic Therapy
In patient
Registries
cardiovascular diseases
Infusions
Intravenous
Stroke
Aged
Retrospective Studies
Aged
80 and over
business.industry
05 social sciences
Minor stroke
Emergency department
Thrombolysis
Middle Aged
medicine.disease
Treatment Outcome
Tissue Plasminogen Activator
Anesthesia
Critical Pathways
Female
050211 marketing
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
medicine.drug
Zdroj: Cerebrovascular Diseases. 46:52-58
ISSN: 1421-9786
1015-9770
DOI: 10.1159/000492123
Popis: Background: The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient’s stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA). Methods: We included consecutive patients who received IV tPA during a 1.5 year-period in 5 hospitals. Minor stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score < 5. We compared various intervals from arrival at the ED to treatment between patients with minor stroke and those with non-minor stroke (NIHSS score ≥5). Delayed treatment was defined as a door-to-needle time > 40 min. Results: During the study period, 356 patients received IV tPA treatment. The median door-to-needle time was significantly longer in the minor stroke group than it was in the non-minor stroke group (43 min [interquartile range [IQR] 35.5–55.5] vs. 37 min [IQR 30–46], p < 0.001). The minor stroke group had a significantly longer door-to-notification time (7 min [IQR 4.5–12] vs. 5 min [IQR 3–8], p < 0.001) and door-to-imaging time (20 min [IQR 15–26.5] vs. 16 min [IQR 11–21], p < 0.001) than did the non-minor stroke group. However, the imaging-to-needle time was not different between the groups. Multivariable analyses revealed that minor stroke was associated with delayed treatment (OR 2.54 [95% CI 1.52–4.30], p = 0.001). Conclusions: Our findings show that the door-to-needle time was longer in patients with minor stroke than it was in those with non-minor stroke, mainly owing to delayed action in the initial steps of neurology notification and imaging. Our findings suggest that some quality improvement initiatives are necessary for patients with suspected stroke with minor symptoms.
Databáze: OpenAIRE
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