Department of Internal Medicine (Neurology), University of Manitoba, Manitoba, R3A 1R9, Canada.
Can J Neurol Sci. 2012 Nov;39(6):789-92. doi: 10.1017/s0317167100015626.
The benefits of intravenous recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke is time dependent. Guidelines recommend a door-to-needle (DTN) time of less than 60 minutes.
A retrospective audit of 730 stroke charts from 2008 - 2011 was conducted at Health Sciences Centre. 158 patients treated with IV rt-PA were identified. The time intervals between Emergency Department (ED) arrival, administration of rt-PA and uninfused brain computed axial tomographic scan (CT) were recorded. From this, CT to needle times were calculated. During November 2010 to January 2011 feedback was given to neurologists, ED physicians, ED nurses, and CT technologists. This raised awareness and emphasized the importance of this time driven protocol.
The median DTN times for 2008, 2009, and 2010 were 69, 71 and 76 minutes respectively. The median CT-to-needle time for this time period was 47 minutes. In 2011 (n =58) the median DTN time was 49 minutes and the median CT-to-needle was 18 minutes, which were marked improvements (p<0.00005 and p<0.005, respectively). In 2008-2010 only 31% of treated patients (n=100) received rt-PA within 60 minutes, whereas in 2011 this increased to 64%.
Dramatic improvements in DTN times and in the percentage of patients receiving rt-PA treatment within 60 minutes were observed in 2011 after feedback was provided regarding the suboptimal performance. Prior to receiving feedback, DTN times were similar to national median DTN times. All centres administering rt-PA for acute ischemic stroke should monitor their clinical performance and give feedback on a regular basis.
静脉注射重组组织纤溶酶原激活物（rt-PA）治疗急性缺血性脑卒中的疗效与时间相关。指南建议门到针时间（DTN）应少于 60 分钟。
对 2008 年至 2011 年期间在健康科学中心的 730 份脑卒中病历进行了回顾性审核。共发现 158 例接受 IV rt-PA 治疗的患者。记录了从急诊科（ED）到达、rt-PA 给药和未输注脑计算机轴向断层扫描（CT）之间的时间间隔。由此计算出 CT 至针时间。2010 年 11 月至 2011 年 1 月期间，向神经科医生、ED 医生、ED 护士和 CT 技术员提供了反馈。这提高了他们的认识并强调了这个时间驱动方案的重要性。
2008 年、2009 年和 2010 年的中位 DTN 时间分别为 69、71 和 76 分钟。在此期间，中位 CT 至针时间为 47 分钟。2011 年（n=58）的中位 DTN 时间为 49 分钟，中位 CT 至针时间为 18 分钟，均有显著改善（p<0.00005 和 p<0.005）。2008 年至 2010 年，只有 31%（n=100）的治疗患者在 60 分钟内接受 rt-PA 治疗，而 2011 年这一比例增加到 64%。
在提供了关于表现不佳的反馈后，2011 年观察到 DTN 时间和在 60 分钟内接受 rt-PA 治疗的患者比例显著改善。在收到反馈之前，DTN 时间与全国中位数 DTN 时间相似。所有管理急性缺血性脑卒中 rt-PA 的中心都应监测其临床绩效并定期提供反馈。
