Iglesias Mohedano Ana María, García Pastor Andrés, Díaz Otero Fernando, Vázquez Alen Pilar, Vales Montero Marta, Luque Buzo Elisa, Redondo Ráfales Nuria, Chavarria Cano Beatriz, Fernández Bullido Yolanda, Villanueva Osorio Jose Antonio, Gil Núñez Antonio
Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1817-1823. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.015. Epub 2017 May 15.
Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times.
Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014. A series of measures aimed at reducing in-hospital delays were implemented. We compared DTI, ITN, and DTN times between patients who underwent the interventions and those who did not.
231 patients. DTI time was lower when personal history was reviewed and tests were ordered before patient arrival (2.5 minutes saved, P = .016) and when electrocardiogram was not made (5.4 minutes saved, P < .001). Not performing a computed tomography angiography and not waiting for coagulation results from laboratory before intravenous thrombolysis (25.5%) reduced ITN time significantly (14 and 12 minutes saved, respectively, P < .001). These interventions remained as independent predictors of a shorter ITN and DTN time. Completing all steps resulted in the lowest DTI and ITN times (13 and 19 minutes, respectively).
Every measure is an important part of a chain focused on saving time in acute stroke: the lowest DTI and ITN times were obtained when all steps were completed. Measures shortening ITN time produced a greater impact on DTN time reduction; therefore, ITN interventions should be considered a critical part of new protocols and guidelines.
治疗时间仍然是急性缺血性卒中预后的最重要因素。我们对减少急性卒中管理中医院内延误的新干预措施的效果进行了量化，并评估了其对门到影像（DTI）、影像到穿刺（ITN）和门到穿刺（DTN）时间的影响。
对2014年2月1日至12月31日在一家三级医院就诊的连续卒中患者进行前瞻性登记，这些患者均为再灌注治疗的候选者。实施了一系列旨在减少院内延误的措施。我们比较了接受干预的患者与未接受干预的患者的DTI、ITN和DTN时间。
共231例患者。在患者到达之前回顾个人病史并下达检查医嘱时，DTI时间更短（节省2.5分钟，P = 0.016），且未进行心电图检查时DTI时间也更短（节省5.4分钟，P < 0.001）。不进行计算机断层血管造影以及在静脉溶栓前不等待实验室凝血结果（25.5%）可显著缩短ITN时间（分别节省14分钟和12分钟，P < 0.001）。这些干预措施仍然是ITN和DTN时间较短的独立预测因素。完成所有步骤可使DTI和ITN时间最短（分别为13分钟和19分钟）。
每一项措施都是急性卒中时间节省链的重要组成部分：当所有步骤都完成时，DTI和ITN时间最短。缩短ITN时间的措施对减少DTN时间产生了更大影响；因此，ITN干预措施应被视为新方案和指南的关键部分。
