Reducing time delays in the management of ischemic stroke patients in Northern Italy.
Int J Cardiol
; 215: 431-4, 2016 Jul 15.
Article
em En
| MEDLINE
| ID: mdl-27131264
ABSTRACT
BACKGROUND AND PURPOSE:
Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections. MATERIALS ANDMETHODS:
Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals pre-hospital, in-hospital and total times. Previous corrective interventions were 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression.RESULTS:
1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (p<0.001). Thrombolytic treatment was performed in 4.7% of patients. Median pre-hospital and in-hospital times were 113 and 105min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p<0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5hours from symptom onset was performed in 14% of patients more than the first phase of study.CONCLUSIONS:
The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Terapia Trombolítica
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Acidente Vascular Cerebral
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Serviços Médicos de Emergência
Tipo de estudo:
Prognostic_studies
Limite:
Aged
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Aged80
/
Female
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Humans
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Male
/
Middle aged
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article