Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Neurointerv Surg. 2018 May;10(5):424-428. doi: 10.1136/neurintsurg-2017-013198. Epub 2017 Aug 30.
The effect of intra-arterial treatment (IAT) for acute ischemic stroke is highly time-dependent. We investigated the delay of IAT and factors associated with such delay.
MR CLEAN was a randomized trial of IAT plus usual care versus usual care alone (n=500). With multivariable linear regression, we analyzed the effect of intravenous treatment, general anesthesia, off-hours and inter-hospital transfer on time to admission to the emergency department (ED) of the intervention center and time to treatment. Furthermore, we assessed compliance with a target of 75 min for time from ED to treatment, and calculated the potential absolute increase in the number of patients with a good outcome (modified Rankin Scale score ≤2) if this target had been achieved in all treated patients.
Inter-hospital transfer prolonged time to ED by 140 min (95% CI 129 to 150) but reduced time from ED to treatment by 77 min (95% CI 64 to 91). Time from ED to treatment was increased by 19 min by general anesthesia (95% CI 5 to 33) and total time was increased by 23 min during off-hours (95% CI 6 to 40). The in-hospital target was achieved in 11.5% (22/192) of patients. Full compliance with the target time of 75 min from ED to treatment would have increased the proportion of patients with a good outcome by 7.6% (95% CI 6.7% to 8.5%).
Inter-hospital transfer is an important cause of delay in the delivery of IAT and every effort should be made to avoid transfers and reduce transfer-related delay. Furthermore, in-hospital workflow should be optimized to improve functional outcome after IAT.
急性缺血性脑卒中的动脉内治疗（IAT）效果高度依赖时间。我们研究了 IAT 的延迟及其相关因素。
MR CLEAN 是一项比较 IAT 加常规治疗与单纯常规治疗的随机试验（n=500）。我们采用多变量线性回归分析，分析静脉治疗、全身麻醉、非工作时间和医院间转院对干预中心急诊室（ED）入院时间和治疗时间的影响。此外，我们评估了在 ED 至治疗时间达到 75 分钟目标的依从性，并计算了如果所有接受治疗的患者都达到这一目标，治疗后良好结局（改良 Rankin 量表评分≤2）患者数量的潜在绝对增加。
医院间转院使 ED 至入院时间延长了 140 分钟（95% CI 129 至 150），但使 ED 至治疗时间缩短了 77 分钟（95% CI 64 至 91）。全身麻醉使治疗时间增加了 19 分钟（95% CI 5 至 33），非工作时间使总时间增加了 23 分钟（95% CI 6 至 40）。在 192 例患者中，有 11.5%（22/192）达到了院内目标。如果 ED 至治疗时间的目标时间达到 75 分钟，将使良好结局患者的比例增加 7.6%（95% CI 6.7%至 8.5%）。
医院间转院是 IAT 延误的一个重要原因，应尽一切努力避免转院并减少转院相关延误。此外，应优化院内工作流程，以提高 IAT 后的功能结局。
