Cone David C, Cooley Craig, Ferguson Jeffrey, Harrell Andrew J, Luk Jeffrey H, Martin-Gill Christian, Marquis Sean W, Pasichow Scott
Prehosp Emerg Care. 2018 Jan-Feb;22(1):1-6. doi: 10.1080/10903127.2017.1356410. Epub 2017 Aug 25.
In an effort to decrease door-to-needle times for patients with acute ischemic stroke, some hospitals have begun taking stable EMS patients with suspected stroke directly from the ambulance to the CT scanner, then to an emergency department (ED) bed for evaluation. Minimal data exist regarding the potential for time savings with such a protocol. The study hypothesis was that a direct-to-CT protocol would be associated with decreases in both door-to-CT-ordered and door-to-needle times.
An observational, multicenter before/after study was conducted of time/process measures at hospitals that have implemented direct-to-CT protocols for patients transported by EMS with suspected stroke. Participating hospitals submitted data on at least the last 50 "EMS stroke alert" patients before the launch of the direct-to-CT protocol, and at least the first 50 patients after. Time elements studied were arrival at the ED, time the head CT was ordered, and time tPA was started. Data were submitted in blinded fashion (patient and hospital identifiers removed); at the time of data analysis, the lead investigator was unaware of which data came from which hospital. Simple descriptive statistics were used, along with the Mann-Whitney test to compare time medians.
Seven hospitals contributed data on 1040 patients (529 "before" and 511 "after"); 512 were male, and 627 had final diagnoses of ischemic stroke, of whom 275 received tPA. The median door-to-CT-ordered time for all patients was 7 minutes in the before phase, and 4 minutes after (difference 3 minutes, p = < 0.0001); similarly, the median door-to-CT-started time was 6 minutes "before" and 10 minutes after (p < 0.0001). The median door-to-needle time for all patients given tPA was 42 minutes before, and 44 minutes after (p = 0.78). Four hospitals had modest decreases in door-to-CT-ordered time (of 2, 4, 2, and 5 minutes), and only one hospital had a decrease in door-to-needle time (32 min vs 26 min, p = 0.012).
In this sample from seven hospitals, a minimal reduction in door-to-CT-ordered and door-to-CT-started time, but no change in door-to-needle time, was found for EMS patients with suspected stroke taken directly to the CT scanner, compared to those evaluated in the ED prior to CT.
为了缩短急性缺血性中风患者的门到针时间，一些医院已开始将疑似中风的病情稳定的急救医疗服务（EMS）患者直接从救护车送往CT扫描仪，然后送到急诊科（ED）病床进行评估。关于这种方案节省时间的可能性，现有数据极少。研究假设是直接到CT方案将与门到CT医嘱时间和门到针时间的减少相关。
对已为通过EMS转运的疑似中风患者实施直接到CT方案的医院，进行了一项观察性多中心前后研究，以测量时间/流程。参与研究的医院提交了至少在直接到CT方案实施前的最后50例“EMS中风警报”患者的数据，以及至少实施后的前50例患者的数据。研究的时间要素包括到达急诊科的时间、头部CT医嘱开出时间和开始使用组织型纤溶酶原激活剂（tPA）的时间。数据以盲法提交（去除患者和医院标识符）；在数据分析时，首席研究员不知道哪些数据来自哪家医院。使用了简单描述性统计以及Mann-Whitney检验来比较时间中位数。
七家医院提供了1040例患者的数据（529例“之前”和511例“之后”）；512例为男性，627例最终诊断为缺血性中风，其中275例接受了tPA治疗。所有患者的门到CT医嘱时间中位数在之前阶段为7分钟，之后为4分钟（差值3分钟，p = < 0.0001）；同样，门到CT开始时间中位数“之前”为6分钟，之后为10分钟（p < 0.0001）。所有接受tPA治疗患者的门到针时间中位数之前为42分钟，之后为44分钟（p = 0.78）。四家医院的门到CT医嘱时间有适度减少（分别为2、4、2和5分钟），只有一家医院的门到针时间减少（32分钟对26分钟，p = 0.012）。
在来自七家医院的这个样本中，与在CT检查前在急诊科进行评估的患者相比，直接送往CT扫描仪的疑似中风的EMS患者在门到CT医嘱时间和门到CT开始时间上有最小程度的减少，但门到针时间没有变化。
