Greenberg Karen, Maxwell Christina R, Moore Keisha D, D'Ambrosio Michael, Liebman Kenneth, Veznedaroglu Erol, Sanfillippo Geri, Diaz Cynthia, Binning Mandy J
Capital Health Regional Medical Center, Trenton, NJ, USA; Capital Institutes for Neurosciences, Pennington, NJ, USA.
Capital Health Regional Medical Center, Trenton, NJ, USA; Capital Institutes for Neurosciences, Pennington, NJ, USA.
Am J Emerg Med. 2015 Feb;33(2):234-7. doi: 10.1016/j.ajem.2014.11.025. Epub 2014 Nov 28.
The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
This is a retrospective study evaluating DTN time, discharge outcomes, and discharge location in acute stroke patients who received IV tPA at our comprehensive stroke center. These outcome measures were compared between patients who were evaluated and treated in our neuro ED to those treated in our main ED.
From 2012 to 2014, 67 acute stroke patients received IV tPA in our ED. Thirty-five patients were evaluated in the neuro ED, and 32, in the main ED. Average DTN times were significantly faster in the neuro ED at 35 minutes, compared to main ED DTN times of 83 minutes. Discharge NIHSS score was significantly lower, and more patients were discharged to home in the neuro ED group compared to the main ED group.
Trained neuro ED physicians can safely give IV tPA independently for stroke patients with improved DTN times, lower discharge NIHSS, and higher likelihood of being discharged to home compared to the main ED physicians who used teleneurology consultation. This suggests utility in training emergency medicine physicians to administer tPA independently based on clinical practice guidelines.
我们医疗中心的神经科急诊科（神经急诊科）由接受过专门神经科学培训的急诊医学医生 staffed ，他们独立为急性缺血性中风患者静脉注射（IV）组织纤溶酶原激活剂（tPA）。研究了神经急诊科和主急诊科之间的门到针（DTN）时间、出院地点和出院时美国国立卫生研究院卒中量表（NIHSS）评分，假设神经急诊科组的所有指标都会更好。
这是一项回顾性研究，评估了在我们的综合卒中中心接受静脉注射tPA的急性中风患者的DTN时间、出院结果和出院地点。将在我们神经急诊科接受评估和治疗的患者与在主急诊科接受治疗的患者的这些结果指标进行了比较。
2012年至2014年，67例急性中风患者在我们的急诊科接受了静脉注射tPA。35例患者在神经急诊科接受评估，32例在主急诊科接受评估。神经急诊科的平均DTN时间明显更快，为35分钟，而主急诊科的DTN时间为83分钟。与主急诊科组相比，神经急诊科组的出院NIHSS评分明显更低，更多患者出院回家。
与使用远程神经学咨询的主急诊科医生相比，经过培训的神经急诊科医生可以安全地独立为中风患者静脉注射tPA，DTN时间缩短，出院NIHSS评分更低，出院回家的可能性更高。这表明培训急诊医学医生根据临床实践指南独立使用tPA具有实用性。
