Birnbaum Lee A, Rodriguez Jesse S, Topel Christopher H, Behrouz Reza, Misra Vivek, Palacio Santiago, Patterson Michele G, Motz Deb S, Goros Martin W, Cornell John E, Caron Jean-Louis R
Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas.
Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas.
J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2668-2672. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.013. Epub 2016 Jul 28.
The timely administration of intravenous (IV) tissue plasminogen activator (t-PA) to acute ischemic stroke patients from the period of symptom presentation to treatment, door-to-needle (DTN) time, is an important focus for quality improvement and best clinical practice.
A retrospective review of our Get With The Guidelines database was performed for a 5-hospital telestroke network for the period between January 2010 and January 2015. All acute ischemic stroke patients who were triaged in the emergency departments connected to the telestroke network and received IV t-PA were included. Optimal DTN time was defined as less than 60 minutes. Logistic regression was performed with clinical variables associated with DTN time. Age and National Institutes of Health Stroke Scale (NIHSS) score were categorized based on clinically significant cutoffs.
Six-hundred and fifty-two patients (51% women, 46% White, 45% Hispanic, and 8% Black) were included in this study. The mean age was 70 years (range 29-98). Of the variables analyzed, only arrival mode, initial NIHSS score, and the interaction between age and initial NIHSS score were significant. DTN time more than or equal to 60 minutes was most common in patients aged more than 80 years with NIHSS score higher than 10.
The cause of DTN time delay for older patients with higher NIHSS score is unclear but was not related to presenting blood pressure or arrival mode. Further study of this subgroup is important to reduce overall DTN times.
对于急性缺血性中风患者，从症状出现到治疗的静脉注射（IV）组织纤溶酶原激活剂（t-PA）的及时给药，即门到针（DTN）时间，是质量改进和最佳临床实践的重要关注点。
对2010年1月至2015年1月期间一个由5家医院组成的远程卒中网络的“遵循指南”数据库进行回顾性研究。纳入所有在与远程卒中网络相连的急诊科接受分诊并接受静脉注射t-PA的急性缺血性中风患者。最佳DTN时间定义为少于60分钟。对与DTN时间相关的临床变量进行逻辑回归分析。根据具有临床意义的临界值对年龄和美国国立卫生研究院卒中量表（NIHSS）评分进行分类。
本研究纳入了652例患者（51%为女性，46%为白人，45%为西班牙裔，8%为黑人）。平均年龄为70岁（范围29 - 98岁）。在分析的变量中，只有到达方式、初始NIHSS评分以及年龄与初始NIHSS评分之间的相互作用具有统计学意义。DTN时间大于或等于60分钟在年龄大于80岁且NIHSS评分高于10分的患者中最为常见。
NIHSS评分较高的老年患者DTN时间延迟的原因尚不清楚，但与就诊时血压或到达方式无关。对这一亚组进行进一步研究对于缩短总体DTN时间很重要。
