Marto João Pedro, Borbinha Cláudia, Calado Sofia, Viana-Baptista Miguel
Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
J Stroke Cerebrovasc Dis. 2016 Sep;25(9):2305-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.023. Epub 2016 Jun 23.
In acute stroke patients' treatment, time is of utmost importance. Significant efforts must be made to reduce door-to-needle time (DNT), taking into account its effect on treatment efficacy and patients' prognosis. The objective of this study is to assess the effect of implementing a countdown timer in the acute stroke emergency room, on door-to-computed tomography time (DCTT) and DNT.
Implementation of protocol that postulates the activation of a countdown timer every time an acute stroke patient is admitted. DCTT and DNT in patients submitted to thrombolysis were compared before and after the implementation of the chronometer. Multivariate analysis of DNT and DCTT was conducted adjusted to age, sex, National Institutes of Health Stroke Scale at admission, time from stroke onset to admission, and anterior circulation.
Of the 76 patients treated with thrombolysis in 2015 in our hospital, 71 had stroke code activation by the emergency medical services or at hospital admission. Protocol was initiated on July 1, with 41 patients (58%) included in the second semester. The Stroke Chronometer implementation resulted in a reduction of the mean DCTT from 27.1 to 18.4 minutes (P = .004; 95% CI 2.56-12.45) and of the mean DNT from 52.7 to 39.2 minutes (P = .016; 95% CI 2.49-23.18), respectively, first and second semesters.
The Stroke Chronometer strategy has revealed to be an effective method to reduce DCTT and DNT.
在急性卒中患者的治疗中，时间至关重要。必须做出巨大努力来缩短从入院到静脉溶栓的时间（DNT），因为这会影响治疗效果和患者预后。本研究的目的是评估在急性卒中急诊室实施倒计时器对从入院到计算机断层扫描时间（DCTT）和DNT的影响。
实施一项方案，规定每次收治急性卒中患者时启动倒计时器。比较了实施计时器前后接受溶栓治疗患者的DCTT和DNT。对DNT和DCTT进行多因素分析，并根据年龄、性别、入院时美国国立卫生研究院卒中量表评分、卒中发作至入院时间以及前循环情况进行校正。
2015年我院76例接受溶栓治疗的患者中，71例由急诊医疗服务机构或入院时激活了卒中代码。该方案于7月1日启动，第二学期纳入41例患者（58%）。实施卒中计时器后，第一学期和第二学期的平均DCTT分别从27.1分钟降至18.4分钟（P = 0.004；95%CI 2.56 - 12.45），平均DNT分别从52.7分钟降至39.2分钟（P = 0.016；95%CI 2.49 - 23.18）。
卒中计时器策略已被证明是一种减少DCTT和DNT的有效方法。
