Lin Cheryl B, Peterson Eric D, Smith Eric E, Saver Jeffrey L, Liang Li, Xian Ying, Olson Daiwai M, Shah Bimal R, Hernandez Adrian F, Schwamm Lee H, Fonarow Gregg C
Duke-National University of Singapore Graduate Medical School, Singapore.
Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):514-22. doi: 10.1161/CIRCOUTCOMES.112.965210. Epub 2012 Jul 10.
The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent. Emergency medical services (EMS) hospital prenotification of an incoming patient with potential stroke may provide a means of reducing evaluation and treatment times and improving treatment rates; yet, available data are limited.
We examined 371 988 patients with acute ischemic stroke transported by EMS and enrolled in Get With The Guidelines-Stroke from April 1, 2003, to March 31, 2011. Prenotification occurred in 249 197 (67.0%) of EMS-transported patients. Among eligible patients arriving by 2 hours, patients with EMS prenotification were more likely to be treated with tPA within 3 hours (82.8% versus 79.2%, absolute difference +3.5%, P<0.0001, the National Institutes of Health Stroke Scale-documented cohort; 73.0% versus 64.0%, absolute difference +9.0%, P<0.0001, overall cohort). Patients with EMS prenotification had shorter door-to-imaging times (26 minutes versus 31 minutes, P<0.0001), shorter door-to-needle times (78 minutes versus 80 minutes, P<0.0001), and shorter symptom onset-to-needle times (141 minutes versus 145 minutes, P<0.0001). In multivariable and modified Poisson regression analyses accounting for the clustering of patients within hospitals, use of EMS prenotification was independently associated with greater likelihood of door-to-imaging times ≤25 minutes, door-to-needle times for tPA ≤60 minutes, onset-to-needle times ≤120 minutes, and tPA use within 3 hours.
EMS hospital prenotification is associated with improved evaluation, timelier stroke treatment, and more eligible patients treated with tPA. These results support the need for initiatives targeted at increasing EMS prenotification rates as a mechanism from improving quality of care and outcomes in stroke.
静脉注射组织型纤溶酶原激活剂（tPA）治疗急性缺血性卒中的益处具有时间依赖性。紧急医疗服务（EMS）提前通知医院有潜在卒中的患者前来就诊，可能是缩短评估和治疗时间、提高治疗率的一种方式；然而，现有数据有限。
我们研究了2003年4月1日至2011年3月31日期间由EMS转运并纳入“遵循卒中治疗指南”的371988例急性缺血性卒中患者。249197例（67.0%）由EMS转运的患者进行了提前通知。在2小时内到达的符合条件的患者中，有EMS提前通知的患者更有可能在3小时内接受tPA治疗（国立卫生研究院卒中量表记录队列中，82.8%对79.2%，绝对差异+3.5%，P<0.0001；总体队列中，73.0%对64.0%，绝对差异+9.0%，P<0.0001）。有EMS提前通知的患者从入院到影像检查的时间更短（26分钟对31分钟，P<0.0001），从入院到穿刺的时间更短（78分钟对80分钟，P<0.0001），症状发作到穿刺的时间更短（141分钟对145分钟，P<0.0001）。在考虑医院内患者聚集情况的多变量和修正泊松回归分析中，使用EMS提前通知与入院到影像检查时间≤25分钟、tPA治疗的入院到穿刺时间≤60分钟、发作到穿刺时间≤120分钟以及3小时内使用tPA的可能性更大独立相关。
EMS提前通知医院与改善评估、更及时的卒中治疗以及更多符合条件的患者接受tPA治疗相关。这些结果支持需要采取措施提高EMS提前通知率，作为改善卒中护理质量和结局的一种机制。
