Department of Neurology, University Hospital of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
Int J Stroke. 2011 Dec;6(6):493-7. doi: 10.1111/j.1747-4949.2011.00585.x. Epub 2011 Feb 17.
Intravenous thrombolysis for acute stroke is more efficient the earlier the treatment is initiated. In-hospital delays account for a significant proportion of avoidable time loss before treatment is initiated. Paradoxically, studies have reported longer door-to-needle times the earlier the patients arrive ('three-hour effect'). Hypothesis We hypothesized that a standardized thrombolysis procedure carried out in a specialized neurological emergency room can minimize in-hospital delays and erase the 'three-hour effect'.
Onset-to-door and door-to-needle times of 246 consecutive thrombolysis patients were analyzed. A standardized protocol designed to minimize in-hospital delays was tested using a resident-based stroke team within a neurological emergency room. Correlation of onset-to-door and door-to-needle times was measured as well as differences in treatment times for daytime versus night hours and weekend vs. weekday. Outcome, rate of symptomatic intracranial hemorrhage and mortality were compared with the results of SITS-MOST.
Median door-to-needle time was 25 min compared with a mean of 68 min in SITS-MOST. door-to-needle time did not correlate with onset-to-door time (Pearson's r = -0 · 097; P = 0 · 13) and patients arriving within 90 min from symptom onset showed comparable door-to-needle times with patients arriving within 90-180 min. Neither treatment on weekends nor during night hours led to significant in-hospital treatment delays. Outcome and safety parameters were comparable with those observed in SITS-MOST.
By applying a standardized and diligently monitored thrombolysis protocol, carried out by a specialized stroke team within a neurological emergency room, in-hospital delays can be minimized. This allows improvement of door-to-needle times irrespective of the time to arrival and treatment during off-hours.
急性脑卒中的静脉溶栓治疗越早，效果越好。在开始治疗之前，医院内的延误占可避免的时间损失的很大一部分。矛盾的是，研究报告称，患者到达时间越早（“三小时效应”），门到针的时间反而越长。假设我们假设在专门的神经急救室中进行标准化的溶栓程序可以最大程度地减少医院内的延误，并消除“三小时效应”。
分析了 246 例连续溶栓患者的发病至入院时间和门到针时间。在神经急救室内，使用基于住院医师的卒中小组测试了一种旨在最大程度减少医院内延误的标准化方案。测量了发病至入院时间和门到针时间之间的相关性，以及白天与夜间、周末与工作日之间的治疗时间差异。并将症状性颅内出血率和死亡率的结果与 SITS-MOST 的结果进行比较。
中位门到针时间为 25 分钟，而 SITS-MOST 的平均时间为 68 分钟。门到针时间与发病至入院时间无相关性（Pearson r = -0.097；P = 0.13），且发病后 90 分钟内到达的患者与 90-180 分钟内到达的患者门到针时间相当。周末或夜间治疗均不会导致明显的院内治疗延误。结果和安全性参数与 SITS-MOST 观察到的相似。
通过在神经急救室内由专门的卒中小组应用标准化且经过严格监测的溶栓方案，可以最大程度地减少院内延误。这使得无论到达时间如何，都可以改善门到针时间，并且在非工作时间内也可以进行治疗。
