KMID : 0385920060170050424
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Journal of the Korean Society of Emergency Medicine 2006 Volume.17 No. 5 p.424 ~ p.430
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Diagnosis and Treatment of Patients With Acute Neurologic Symptoms Using a Coordinated Response Protocol
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Sung Chang-Min
Kim Eui-Chung Yoon Yoo-Sang Chung Hyun-Soo Park In-Cheol Heo Ji-Hoe
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Abstract
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Purpose: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential.
Methods: Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital¡¯s ED with an acute neurologic symptoms and an onset time of less than 12hours.
Results: Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47¡¾19 minutes and 26¡¾12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96¡¾16 minutes and 67¡¾28 minutes, respectively (pvalue=0.035).
Conclusion: Assembly of a specific ¡°stroke team¡±and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.
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KEYWORD
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Medical Records, Stroke, Cerebral Infarction
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