Mehdiratta M, Woolfenden A R, Chapman K M, Johnston Dean C, Schulzer M, Beckman J, Teal P A
Division of Neurology, Vancouver Hospital & Health Sciences Center, BC, Canada.
Can J Neurol Sci. 2006 May;33(2):214-6. doi: 10.1017/s031716710000500x.
To determine the effectiveness of an Acute Stroke Triage Pathway in reducing door to needle times in acute stroke treatment with IV t-PA.
A previous study at our tertiary referral centre, examining IV t-PA door to needle times, was completed in 2000. The median door to needle time was beyond the recommended National Institute for Neurological Disorders and Stroke (NINDS) standard of 60 minutes. In November 2001, an Acute Stroke Triage Pathway was introduced in the emergency room (ER) to address this issue. The goal of this pathway was to rapidly identify patients eligible for treatment for IV t-PA, so that CT scans and lab studies could be arranged immediately upon ER arrival. Our hypothesis was that the Triage Pathway would shorten door to CT and door to needle times.
DESIGN/METHODS: Using retrospective data, pre (n=87) and post (n=47) triage pathway times were compared. The door to CT time was reduced by 11 minutes (p=0.015) and door to needle time was reduced by 18 minutes (p=0.0036) in a subgroup of patients that presented directly to our hospital.
These results indicate that the Acute Stroke Triage Pathway is effective in reducing Door to CT and Door to Needle Times in patients presenting directly to our ER. However, a majority of treatment times were still beyond NINDS recommendations. Stroke Centers require periodic review of their efficiency to ensure that target times are being obtained and may benefit from the use of an Acute Stroke Triage Pathway.
确定急性卒中分诊路径在降低静脉注射组织型纤溶酶原激活剂（IV t-PA）治疗急性卒中时的门到针时间方面的有效性。
我们的三级转诊中心此前在2000年完成了一项关于IV t-PA门到针时间的研究。门到针时间的中位数超过了美国国立神经疾病和中风研究所（NINDS）推荐的60分钟标准。2001年11月，急诊室（ER）引入了急性卒中分诊路径以解决这一问题。该路径的目标是快速识别适合IV t-PA治疗的患者，以便在患者到达急诊室后立即安排CT扫描和实验室检查。我们的假设是分诊路径将缩短门到CT时间和门到针时间。
设计/方法：利用回顾性数据，比较了分诊路径实施前（n = 87）和实施后（n = 47）的时间。在直接到我院就诊的患者亚组中，门到CT时间缩短了11分钟（p = 0.015），门到针时间缩短了18分钟（p = 0.0036）。
这些结果表明，急性卒中分诊路径在降低直接到我们急诊室就诊患者的门到CT时间和门到针时间方面是有效的。然而，大多数治疗时间仍超出NINDS的建议。卒中中心需要定期审查其效率，以确保达到目标时间，并可能受益于使用急性卒中分诊路径。
