Patrick Andreas Eder1,2, Gunter Laux2, Asarnusch Rashid1, Tobias Kniess3, Karl Georg Haeusler4, Layal Shammas1, Bernd Griewing5, Susanne Hofmann6, Stephanie Stangl7, Silke Wiedmann8, Viktoria Rücker7, Peter U Heuschmann7,9, Hassan Soda6. 1. Innovation management, Zentrum für Telemedizin Bad Kissingen, Bad Kissingen, Germany. 2. Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. 3. Department of Neurological Rehabilitation, Campus Rhön Klinikum AG, Bad Neustadt/Saale, Germany. 4. Department of Neurology, University Hospital Würzburg, Würzburg, Germany. 5. Medical Board Division, Campus Rhön Klinikum AG, Bad Neustadt/Saale, Germany. 6. Department of Neurology, Campus Rhön Klinikum AG, Bad Neustadt/Saale, Germany. 7. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. 8. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 9. Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.
Abstract
INTRODUCTION: Door-to-CT scan time (DCT) and door-to-needle time (DNT) are important process measures in acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis (IVT). We examined the impact of a telemedical prenotification by emergency medical service (EMS) (called the "Stroke Angel" program) on DCT and DNT and IVT rate compared to standard of care. PATIENTS AND METHODS: Two prospective observational studies including AIS patients admitted via EMS from 2011 to 2013 (cohort I; n = 496) and from January 1, 2015 to May 31, 2018 (cohort II; n = 349) were conducted. After cohort I, the 4-Item Stroke Scale and a digital thrombolysis protocol were added. Multivariable logistic and linear regression analysis was performed. RESULTS: In cohort I, DCT was lower in the intervention group (13 vs. 26 min using standard of care; p < 0.001), but no significant difference in median DNT (35 vs. 39 min; p = 0.24) was observed. In cohort II, a reduction of DCT (8 vs. 15 min; p < 0.001) and DNT (25 vs. 29 min p = 0.003) was observed in the intervention group. Compared to standard of care, the likelihood of DCT ≤10 min or DNT ≤20 min in the intervention group was 2.7 (adjusted odds ratio [aOR] 2.7; 95% CI: 2.1-3.5) and 1.8 (aOR 1.8; 95% CI: 1.1-2.9), respectively. In cohort II, IVT rate was higher (aOR 1.4; 95% CI: 1.1-1.9) in the intervention group. CONCLUSION: Although the positive effects of Stroke Angel in AIS provided a rationale for implementation in routine care, larger studies of practice implementation will be needed. Using Stroke Angel in the prehospital management of AIS impacts on important process measures of IVT delivery.
INTRODUCTION: Door-to-CT scan time (DCT) and door-to-needle time (DNT) are important process measures in acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis (IVT). We examined the impact of a telemedical prenotification by emergency medical service (EMS) (called the "Stroke Angel" program) on DCT and DNT and IVT rate compared to standard of care. PATIENTS AND METHODS: Two prospective observational studies including AISpatients admitted via EMS from 2011 to 2013 (cohort I; n = 496) and from January 1, 2015 to May 31, 2018 (cohort II; n = 349) were conducted. After cohort I, the 4-Item Stroke Scale and a digital thrombolysis protocol were added. Multivariable logistic and linear regression analysis was performed. RESULTS: In cohort I, DCT was lower in the intervention group (13 vs. 26 min using standard of care; p < 0.001), but no significant difference in median DNT (35 vs. 39 min; p = 0.24) was observed. In cohort II, a reduction of DCT (8 vs. 15 min; p < 0.001) and DNT (25 vs. 29 min p = 0.003) was observed in the intervention group. Compared to standard of care, the likelihood of DCT ≤10 min or DNT ≤20 min in the intervention group was 2.7 (adjusted odds ratio [aOR] 2.7; 95% CI: 2.1-3.5) and 1.8 (aOR 1.8; 95% CI: 1.1-2.9), respectively. In cohort II, IVT rate was higher (aOR 1.4; 95% CI: 1.1-1.9) in the intervention group. CONCLUSION: Although the positive effects of Stroke Angel in AIS provided a rationale for implementation in routine care, larger studies of practice implementation will be needed. Using Stroke Angel in the prehospital management of AIS impacts on important process measures of IVT delivery.
Authors: Clemens Möllenhoff; Patrick Andreas Eder; Asarnusch Rashid; Christian Möllenhoff; Ingolf Römer; Bogdan Franczyk Journal: Anaesthesiologie Date: 2022-01-06
Authors: Daniel Lauer; Stephan Bandlow; Maik Rathje; Andreas Seidl; Harald Karutz Journal: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz Date: 2022-09-16 Impact factor: 1.595