Jaiteh Lamin E S, Helwig Stefan A, Jagne Abubacarr, Ragoschke-Schumm Andreas, Sarr Catherine, Walter Silke, Lesmeister Martin, Manitz Matthias, Blaß Sebastian, Weis Sarah, Schlund Verena, Bah Neneh, Kauffmann Jil, Fousse Mathias, Kangankan Sabina, Ramos Cabrera Asmell, Kronfeld Kai, Ruckes Christian, Liu Yang, Nyan Ousman, Fassbender Klaus
From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany.
Neurology. 2017 Jul 11;89(2):144-152. doi: 10.1212/WNL.0000000000004080. Epub 2017 Jun 9.
Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs).
Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years.
At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, < 0.001), temperature (60.0% vs 36.2%; < 0.001), and glucose levels (73.0% vs 58.1%; < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; < 0.05), blood count (73.0% vs 49.3%; < 0.01), renal and liver function tests (50.0% vs 5.6%, < 0.001), aspirin prophylaxis (47.3% vs 9.9%; < 0.001), and physiotherapy (41.9% vs 4.2%; < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals.
Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings.
This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures.
在资源匮乏的国家，标准操作程序（SOPs）可能会改善神经科急诊管理的质量。
在冈比亚的一家大型城市医院（班珠尔）和一家小型农村医院（布里卡马）实施神经科SOPs。作为神经科急诊管理的质量指标，在基线以及实施的第一年和第二年评估关键程序的执行情况。
在班珠尔，第一年干预组的100名患者在急诊管理的一般程序方面的执行率高于105名对照组患者，如神经科检查（99.0%对91.4%；P<0.05）以及呼吸频率评估（98.0%对81.9%，P<0.001）、体温评估（60.0%对36.2%；P<0.001）和血糖水平评估（73.0%对58.1%；P<0.05），此外医生书面指示的执行情况也有所改善（96.0%对88.6%，P<0.05），而其他生命体征的评估没有变化。在中风患者中，与中风相关的程序执行率有所提高：早期CT扫描（24.3%对9.9%；P<0.05）、血常规检查（73.0%对49.3%；P<0.01）、肾肝功能检查（50.0%对5.6%，P<0.001）、阿司匹林预防用药（47.3%对9.9%；P<0.001）以及物理治疗（41.9%对4.2%；P<0.001）。大多数效果持续到第二年评估。在布里卡马医院，SOPs的实施同样可行且有益。然而，两家医院的结果没有显著差异。
实施SOPs是在资源匮乏地区提高神经科急诊管理流程质量的一种现实且低成本的选择。
本研究提供了IV级证据，即对于撒哈拉以南非洲疑似神经科急诊的患者，神经科SOPs提高了指南推荐程序的执行率。
