Department of Neurology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
J Neurol. 2013 Apr;260(4):960-8. doi: 10.1007/s00415-012-6647-7. Epub 2012 Aug 23.
Protracted and partial implementation of treatment with intravenous tissue plasminogen activator (tPA) within 4.5 h after acute stroke onset results in potentially eligible patients not receiving optimal treatment. The goal of this study was to review the performance of various organisational models of acute stroke care delivery, and subsequent attempts to improve implementation of tPA treatment. Publications comprehensively reporting on organisational models to improve implementation of i.v. tPA treatment of acute ischemic stroke patients were selected. The efficacy of organisational models was assessed using process outcome measures: thrombolysis rates, time-dependent operational endpoints (time delays), functional outcomes: safety (rate of symptomatic intracranial hemorrhage, mortality rates) and clinical outcome at 90 days (modified Rankin Scale). Fifty-eight published studies assessing organisational models were identified. Four dominant models of acute stroke care delivery were discerned, i.e., primary and comprehensive stroke centres, telemedicine, and the mobile stroke unit. Performance reported for these models suggest a large variation in administration of thrombolytic therapy (0.7-30 %). Time delays and functional outcomes found varied considerably, just like safety and mortality (0.0-11.5 %, and 3.4-31.9 %, respectively). These findings suggest that improving organisational models for tPA treatment may improve acute stroke care. However, implementation may be hampered by regional variation in acute stroke care capacity, expertise, and a fragmented approach towards organising stroke care.
在急性中风发病后 4.5 小时内，延长和部分实施静脉组织型纤溶酶原激活剂（tPA）治疗会导致潜在符合条件的患者未接受最佳治疗。本研究的目的是回顾急性中风护理提供的各种组织模式的表现，并随后尝试改进 tPA 治疗的实施。选择了全面报告改善静脉注射 tPA 治疗急性缺血性中风患者实施情况的组织模型的出版物。使用过程结果测量来评估组织模型的功效：溶栓率、时间依赖性操作终点（时间延迟）、功能结果：安全性（症状性颅内出血率、死亡率）和 90 天的临床结果（改良 Rankin 量表）。确定了 58 项评估组织模型的已发表研究。发现了四种主要的急性中风护理提供模式，即初级和综合中风中心、远程医疗和移动中风单元。这些模型的报告表现表明溶栓治疗的实施存在很大差异（0.7-30%）。时间延迟和功能结果差异很大，安全性和死亡率也是如此（0.0-11.5%和 3.4-31.9%）。这些发现表明，改善 tPA 治疗的组织模型可能会改善急性中风护理。然而，实施可能会受到急性中风护理能力、专业知识和组织中风护理的分散方法的区域差异的阻碍。
