|
KMID : 1142120170190020196
|
|
Journal of Stroke
2017 Volume.19 No. 2 p.196 ~ p.204
|
|
|
Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis
|
|
Jeon Sang-Beom
Ryoo Seung-Mok
Lee Deok-Hee
Kwon Sun-U.
Jang Seong-Soo
Lee Eun-Jae
Lee Sang-Hun
Han Jung-Hee
Yoon Mi-Jeong
Jeong Soo
Cho Young-Uk
Jo Sung-Yang
Lim Seung-Bok
Kim Joong-Goo
Lee Han-Bin
Jung Seung-Chai
Park Kye-Won
Lee Min-Hwan
Kang Dong-Wha
Suh Dae-Chul
Kim Jong-S.
|
|
|
Abstract
|
|
|
Background and Purpose: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day.
Methods: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016.
Results: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36?57 min) to 20.5 min (IQR 15.8?32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5?212.5 min) to 86.5 min (IQR 67.5?102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035).
Conclusions: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
|
|
|
KEYWORD
|
|
|
Cerebral infarction, Thrombolytic therapy, Tissue plasminogen activator
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
   
|
|