Atsumi Chihiro, Hasegawa Yasuhiro, Tsumura Kohtaro, Ueda Toshihiro, Suzuki Kazunari, Sugiyama Makoto, Nozaki Hiroyuki, Suzuki Shinichi, Nakane Makoto, Nagashima Goro, Kitamura Takayuki, Nikaido Hirofumi, Sasanuma Jinichi
Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
J Stroke Cerebrovasc Dis. 2015 Jan;24(1):183-8. doi: 10.1016/j.jstrokecerebrovasdis.2014.08.013. Epub 2014 Nov 6.
Stroke-bypass transportation to the stroke center by paramedics is important to maximize the efficiency of intravenous tissue plasminogen activator (iv-tPA) therapy. To improve access to stroke thrombolysis, a citywide protocol was launched on January 2007 in Kawasaki City (population 1.4 million) using the Maria Prehospital Stroke Scale (MPSS), and quality assurance monitoring has been performed every 6 months. The aim was to identify whether the citywide quality assurance monitoring improves the process and outcome of iv-tPA therapy.
All of the MPSS-based transportation data prospectively recorded by the Kawasaki City Fire Department and the associated clinical data in the 11 hospitals that accept stroke-bypass transfers were merged every 6 months for the quality assurance monitoring. Clinical indicators such as ambulance call-to-door time, onset-to-needle time, door-to-needle time, frequency of thrombolytic use, and outcome of thrombolytic therapy were analyzed. These clinical indicators were also compared between patients transferred on weekdays and on weekends.
A total of 2049 patients was registered from April 2009 to March 2013. Their mean age was 70.4 ± 13.2 (range, 24-98) years, and 64.3% were male. Ambulance call-to-door time decreased gradually from 37.5 ± 12.5 minutes to 33.9 ± 11.7 minutes over 4 years (P = .000, analysis of variance with the post hoc Dunnett test). Onset-to-needle time and door-to-needle time were similar over the 4 years. Good outcome (modified Rankin Scale score <2) after iv-tPA therapy increased from 24.1% to 35.3% (P = .045, 2010 vs. 2012). No deleterious effect of weekend admission was observed based on these clinical indicators.
A citywide MPSS-based transportation protocol significantly decreased the delay in the ambulance call-to-door time. The implementation of standardized cross-institutional quality assurance programs for acute stroke therapy may improve the process and outcome of iv-tPA therapy in the community.
护理人员将中风患者转运至中风中心对于最大化静脉注射组织型纤溶酶原激活剂（iv - tPA）治疗的效率非常重要。为了改善中风溶栓治疗的可及性，2007年1月在川崎市（人口140万）启动了一项全市范围的方案，使用玛丽亚院前中风量表（MPSS），并且每6个月进行一次质量保证监测。目的是确定全市范围的质量保证监测是否能改善iv - tPA治疗的过程和结果。
川崎市消防部门前瞻性记录的所有基于MPSS的转运数据以及接收中风转运患者的11家医院的相关临床数据每6个月合并一次用于质量保证监测。分析诸如救护车呼叫到门时间、发病到穿刺时间、门到穿刺时间、溶栓使用频率以及溶栓治疗结果等临床指标。还比较了工作日和周末转运患者之间的这些临床指标。
2009年4月至2013年3月共登记了2049例患者。他们的平均年龄为70.4±13.2（范围24 - 98）岁，男性占64.3%。4年期间，救护车呼叫到门时间从37.5±12.5分钟逐渐降至33.9±11.7分钟（P = .000，方差分析及事后Dunnett检验）。4年期间发病到穿刺时间和门到穿刺时间相似。iv - tPA治疗后良好结局（改良Rankin量表评分<2）从24.1%增至35.3%（P = .045，2010年与2012年比较）。基于这些临床指标未观察到周末入院的有害影响。
全市范围基于MPSS的转运方案显著减少了救护车呼叫到门时间的延迟。实施针对急性中风治疗的标准化跨机构质量保证项目可能改善社区中iv - tPA治疗的过程和结果。
