Dickson Robert, Nedelcut Adrian, Nedelcut Melissa McPeek
1Baylor College of Medicine,Houston,TexasUSA.
2University of Texas,Tyler,TexasUSA.
Prehosp Disaster Med. 2017 Jun;32(3):343-347. doi: 10.1017/S1049023X17000097. Epub 2017 Feb 21.
The objective of this study was to evaluate the effect of the Stop Stroke (Pulsara; Bozeman, Montana USA) medical application on door-to-needle (DTN) time in patients presenting to the emergency department (ED) with an acute ischemic stroke (AIS).
This was a retrospective cohort study of the Good Shepherd Health System (Longview, Texas USA) stroke quality improvement dashboard for a 25-month period from February 2012 through February 2014. Data analysis includes all data from Center for Medicare and Medicaid Services (CMS; Baltimore, Maryland USA) reportable cases receiving Tissue Plasminogen Activator (TPA) for AIS during the study period. The primary outcome was mean DTN times before and after initiating Stop Stroke. Secondary outcome was the effect on the DTN≤60-minute benchmark.
During the study period, there were 533 stroke activations (200 before Stop Stroke implementation and 333 after). A total of 68 patients meeting inclusion criteria were analyzed (34 pre-app and 34 post- app). The observed mean DTN times post-app decreased 21 minutes (77 to 56 minutes), a 28% improvement (P=.001). Further, the patients meeting DTN≤60 minutes improved from 32% (11 of 34) to 82% (28 of 34) after the app's implementation.
In this cohort of patients with AIS, Stop Stroke improved mean DTN times and number of patients treated within 60 minutes of arrival. These results demonstrate the app's effect of increasing awareness of suspected AIS and improving coordination of care, evidenced by the magnitude of its effect on treatment times. Dickson R , Nedelcut A , McPeek Nedelcut M . Stop Stroke: a brief report on door-to-needle times and performance after implementing an acute care coordination medical application and implications to Emergency Medical Services. Prehosp Disaster Med. 2017;32(3):343-347.
本研究旨在评估“停止中风”（Pulsara；美国蒙大拿州博兹曼市）医疗应用程序对急性缺血性中风（AIS）患者从就诊到开始溶栓（DTN）时间的影响。
这是一项对善牧健康系统（美国得克萨斯州朗维尤市）中风质量改进仪表盘进行的回顾性队列研究，研究时间为2012年2月至2014年2月的25个月期间。数据分析包括医疗保险和医疗补助服务中心（CMS；美国马里兰州巴尔的摩市）报告的在研究期间接受组织型纤溶酶原激活剂（TPA）治疗AIS的所有病例数据。主要结果是启动“停止中风”应用程序前后的平均DTN时间。次要结果是对DTN≤60分钟基准的影响。
在研究期间，共有533次中风激活事件（在实施“停止中风”应用程序之前有200次，之后有333次）。总共分析了68例符合纳入标准的患者（应用程序实施前34例，实施后34例）。应用程序实施后观察到的平均DTN时间减少了21分钟（从77分钟降至56分钟），改善了28%（P = 0.001）。此外，在应用程序实施后，达到DTN≤60分钟的患者比例从32%（34例中的11例）提高到了82%（34例中的28例）。
在这组AIS患者中，“停止中风”应用程序改善了平均DTN时间以及在到达后60分钟内接受治疗的患者数量。这些结果证明了该应用程序在提高对疑似AIS的认识和改善护理协调方面的作用，其对治疗时间的影响程度证明了这一点。迪克森R、内德尔卡特A、麦克皮克·内德尔卡特M。停止中风：关于实施急性护理协调医疗应用程序后从就诊到开始溶栓时间及表现的简要报告以及对紧急医疗服务的影响。院前灾难医学。2017；32(3):343 - 347。
