Simone Vidale1, Marco Arnaboldi2, Giacomo Bezzi3, Giorgio Bono4, Giampiero Grampa5, Mario Guidotti6, Patrizia Perrone7, Andrea Salmaggi8, Davide Zarcone9, Alberto Zoli10, Elio Agostoni11. 1. Neurological Department & Stroke Unit, Sant'Anna Hospital, Como, Italy. Electronic address: simone.vidale@hsacomo.org. 2. Neurological Department & Stroke Unit, Sant'Anna Hospital, Como, Italy. 3. Neurological Department, Sondrio Hospital, Sondrio, Italy. 4. Neurological Department, Circolo Hospital, Varese, Italy. 5. Neurological Department, Circolo Hospital, Saronno, Italy. 6. Neurological Department, Valduce Hospital, Como, Italy. 7. Neurological Department, Civil Hospital, Legnano, Italy. 8. Neurological Department, A. Manzoni Hospital, Lecco, Italy. 9. Neurological Department, Sant'Antonio Abate Hospital, Gallarate, Italy. 10. AREU Lombardy - Emergency-Urgency Regional Agency, Milan, Italy. 11. Neurological Department, Niguarda Ca' Granda Hospital, Milan, Italy.
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 AND METHODS: 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.
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 AND METHODS: 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.
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Pavla Kadlecová; Anna Czlonkowska; Adam Kobayashi; Miroslav Brozman; Viktor Švigelj; Laszlo Csiba; Klara Fekete; Janika Kõrv; Vida Demarin; Aleksandras Vilionskis; Dalius Jatuzis; Yakup Krespi; Chrissoula Liantinioti; Sotirios Giannopoulos; Robert Mikulik Journal: J Neurol Date: 2017-03-18 Impact factor: 4.849
Authors: Md Golam Hasnain; John R Attia; Shahinoor Akter; Tabassum Rahman; Alix Hall; Isobel J Hubbard; Christopher R Levi; Christine L Paul Journal: Implement Sci Date: 2020-11-04 Impact factor: 7.327