El Sayed Mazen J, El Zahran Tharwat, Tamim Hani
Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon ; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box-11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
Emerg Med Int. 2014;2014:438737. doi: 10.1155/2014/438737. Epub 2014 Jul 16.
Background. Thrombolytic therapy (rt-PA) is approved for ischemic stroke presenting within 4.5 hours of symptoms onset. The rate of utilization of rt-PA is not well described in developing countries. Objectives. Our study examined patient characteristics and outcomes in addition to barriers to rt-PA utilization in a tertiary care center in Beirut, Lebanon. Methods. A retrospective chart review of all adult patients admitted to the emergency department during a one-year period (June 1st, 2009, to June 1st, 2010) with a final discharge diagnosis of ischemic stroke was completed. Descriptive analysis was done followed by a comparison of two groups (IV rt-PA and no IV rt-PA). Results. During the study period, 87 patients met the inclusion criteria and thus were included in the study. The mean age was found to be 71.9 years (SD = 11.8). Most patients arrived by private transport (85.1%). Weakness and loss of speech were the most common presenting signs (56.3%). Thirty-three patients (37.9%) presented within 4.5 hours of symptom onset. Nine patients (10.3%, 95% CI (5.5-18.5)) received rt-PA. The two groups (rt-PA versus non rt-PA) had similar outcomes (mortality, symptomatic intracerebral hemorrhage, modified Rankin scale scores, and residual deficit at hospital discharge). Conclusion. In our setting, rt-PA utilization was higher than expected. Delayed presentation was the main barrier to rt-PA administration. Public education regarding stroke is needed to decrease time from symptoms onset to ED presentation and potentially improve outcomes further.
背景。溶栓治疗（rt-PA）已被批准用于症状发作4.5小时内出现的缺血性卒中。在发展中国家，rt-PA的使用比例尚无充分描述。目的。我们的研究除了调查黎巴嫩贝鲁特一家三级医疗中心rt-PA使用的障碍外，还研究了患者特征及预后情况。方法。对在一年期间（2009年6月1日至2010年6月1日）入住急诊科且最终出院诊断为缺血性卒中的所有成年患者进行回顾性病历审查。先进行描述性分析，然后比较两组（静脉注射rt-PA组和未静脉注射rt-PA组）。结果。在研究期间，87例患者符合纳入标准，因此被纳入研究。发现平均年龄为71.9岁（标准差=11.8）。大多数患者乘坐私人交通工具前来就诊（85.1%）。虚弱和言语丧失是最常见的就诊症状（56.3%）。33例患者（37.9%）在症状发作4.5小时内前来就诊。9例患者（10.3%，95%可信区间（5.5 - 18.5））接受了rt-PA治疗。两组（rt-PA组与非rt-PA组）的预后情况相似（死亡率、症状性脑出血、改良Rankin量表评分以及出院时的残余缺陷）。结论。在我们的研究环境中，rt-PA的使用率高于预期。就诊延迟是rt-PA给药的主要障碍。需要开展关于卒中的公众教育，以减少从症状发作到急诊科就诊的时间，并可能进一步改善预后。
