2017年10月
Improving treatment times for patients with in-hospital stroke using a standardized protocol.
Journal of the neurological sciences
- 巻
- 381
- 号
- 開始ページ
- 68
- 終了ページ
- 73
- 記述言語
- 英語
- 掲載種別
- 研究論文(学術雑誌)
- DOI
- 10.1016/j.jns.2017.08.023
- 出版者・発行元
- ELSEVIER SCIENCE BV
Background. Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol.
Methods: Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008 March 2014) and after implementation (April 2014 December 2016).
Results: Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5 min, p < 0.01) and to first neuroimaging (50 vs. 26.5 min, p < 0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16 min, p = 0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53 min, p = 0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods.
Conclusion: Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.
Methods: Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008 March 2014) and after implementation (April 2014 December 2016).
Results: Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5 min, p < 0.01) and to first neuroimaging (50 vs. 26.5 min, p < 0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16 min, p = 0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53 min, p = 0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods.
Conclusion: Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.
- リンク情報
-
- DOI
- https://doi.org/10.1016/j.jns.2017.08.023
- PubMed
- https://www.ncbi.nlm.nih.gov/pubmed/28991718
- Web of Science
- https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000414819100015&DestApp=WOS_CPL
- URL
- http://europepmc.org/abstract/med/28991718
- ID情報
-
- DOI : 10.1016/j.jns.2017.08.023
- ISSN : 0022-510X
- eISSN : 1878-5883
- ORCIDのPut Code : 44531218
- PubMed ID : 28991718
- Web of Science ID : WOS:000414819100015