BACKGROUND AND PURPOSE: To maximize the benefits of thrombolysis, it is necessary not only to treat more patients, but to deliver treatment as early as possible. The aims of our study were to prospectively evaluate the clinical benefit from reducing delays in the emergency stroke pathway at our district hospital and examine outcomes from scenarios that include extension of the alteplase license. METHODS: We developed a discrete-event simulation from prospective data for patients with stroke arriving at our large district hospital. We modeled current practice and assessed the impact on stroke outcomes of measures to reduce in-hospital delays to alteplase treatment and of extensions to the European license for alteplase from 3 to 4.5 hours and to people aged >80 years. RESULTS: Extension of the time window to 4.5 hours increases the thrombolysis rate by 4%, yielding an additional 2 patients per year with minimal or no disability at 3 months. Time window extension is most effective when combined with a system of prealerts, achieving a thrombolysis rate of 15% and an additional 8 patients per year with minimal or no disability, increasing to 13 patients per year with extension of the license to patients >80 years. CONCLUSIONS: If implemented alone, extension of the time window for alteplase has only a modest additional population disability benefit, but this benefit can be increased 5-fold if time window extension is combined with substantial reductions to in-hospital delays.
BACKGROUND AND PURPOSE: To maximize the benefits of thrombolysis, it is necessary not only to treat more patients, but to deliver treatment as early as possible. The aims of our study were to prospectively evaluate the clinical benefit from reducing delays in the emergency stroke pathway at our district hospital and examine outcomes from scenarios that include extension of the alteplase license. METHODS: We developed a discrete-event simulation from prospective data for patients with stroke arriving at our large district hospital. We modeled current practice and assessed the impact on stroke outcomes of measures to reduce in-hospital delays to alteplase treatment and of extensions to the European license for alteplase from 3 to 4.5 hours and to people aged >80 years. RESULTS: Extension of the time window to 4.5 hours increases the thrombolysis rate by 4%, yielding an additional 2 patients per year with minimal or no disability at 3 months. Time window extension is most effective when combined with a system of prealerts, achieving a thrombolysis rate of 15% and an additional 8 patients per year with minimal or no disability, increasing to 13 patients per year with extension of the license to patients >80 years. CONCLUSIONS: If implemented alone, extension of the time window for alteplase has only a modest additional population disability benefit, but this benefit can be increased 5-fold if time window extension is combined with substantial reductions to in-hospital delays.
Authors: Theodore Eugene Day; Albert Chi; Matthew Harris Rutberg; Ashley J Zahm; Victoria M Otarola; Jeffrey M Feldman; Caroline A Pasquariello Journal: Pediatr Surg Int Date: 2014-01-30 Impact factor: 1.827
Authors: Michael Allen; Kerry Pearn; Thomas Monks; Benjamin D Bray; Richard Everson; Andrew Salmon; Martin James; Ken Stein Journal: BMJ Open Date: 2019-09-17 Impact factor: 2.692
Authors: Maarten M H Lahr; Durk-Jouke van der Zee; Patrick C A J Vroomen; Gert-Jan Luijckx; Erik Buskens Journal: PLoS One Date: 2013-11-18 Impact factor: 3.240
Authors: Thomas Monks; David Worthington; Michael Allen; Martin Pitt; Ken Stein; Martin A James Journal: BMC Health Serv Res Date: 2016-09-29 Impact factor: 2.655
Authors: Maren Ranhoff Hov; Erik Zakariassen; Thomas Lindner; Terje Nome; Kristi G Bache; Jo Røislien; Jostein Gleditsch; Volker Solyga; David Russell; Christian G Lund Journal: J Neuroimaging Date: 2017-07-27 Impact factor: 2.486