Jacoby Joshua S, Draper Heather M, Dumkow Lisa E, Farooq Muhammad U, DeYoung G Robert, Brandt Kasey L
Department of Pharmacy, Mercy Health Saint Mary's Campus, Grand Rapids, MI, USA.
Department of Neurology, Mercy Health Physician Partners, Grand Rapids, MI, USA.
Neurohospitalist. 2018 Apr;8(2):60-65. doi: 10.1177/1941874417729982. Epub 2017 Sep 14.
Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department.
A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality.
A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; = .047).
The EMP involvement in initial stroke care was associated with a significant improvement in DTN time.
急性缺血性卒中患者使用组织型纤溶酶原激活剂（tPA）时，缩短从入院到用药（DTN）时间与改善患者预后相关。急诊医学药剂师（EMPs）可通过评估患者禁忌证、准备并给予tPA来加快tPA的给药速度。本研究的目的是确定EMPs对在急诊科接受tPA治疗的急性缺血性卒中患者的DTN时间和临床结局的影响。
进行了一项回顾性、单中心队列研究，研究对象为2012年8月1日至2014年8月30日期间接受tPA治疗的患者，比较卒中护理中有无EMPs参与时的DTN时间。次要结局包括通过美国国立卫生研究院卒中量表（NIHSS）测量的神经功能状态变化、住院时间、出院处置、症状性颅内出血和院内全因死亡率。
共纳入100例患者。EMPs参与了49例患者的护理。EMPs的参与与DTN时间显著缩短相关（中位数46[四分位间距IQR：34.5 - 67]分钟对58[IQR：45 - 79]分钟；P = 0.019），且与在到达后45分钟内接受tPA相关（49%对25%，比值比[OR]：2.81[95%置信区间[CI]：1.21 - 6.52]）。在tPA治疗后24小时，美国国立卫生研究院卒中量表评分显著改善，有利于EMPs组（中位数NIHSS 1[IQR：0 - 4]对2[IQR：1 - 9.25]；P = 0.047）。
EMPs参与初始卒中护理与DTN时间显著缩短相关。
