Servicio de Neurología, Hospital Universitario Virgen de la Victoria, Málaga, España.
Servicio de Neurología, Hospital Universitario Virgen de la Victoria, Málaga, España.
Neurologia (Engl Ed). 2022 Sep;37(7):543-549. doi: 10.1016/j.nrl.2019.08.002. Epub 2019 Nov 25.
Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site.
We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present.
Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site-resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72minutes, respectively (P=.003). DNTs were 59, 74, and 68minutes (P=.001), respectively, for the on-site, off-site, and off-site-resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends.
DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT.
医院的神经科值班通常是现场值班，但有些值班服务可能是现场外或混合式的。静脉注射组织型纤溶酶原激活剂（tPA）是急性缺血性脑卒中（AIS）主要的再灌注治疗方法之一。本研究评估了神经科医生现场值班和非现场值班时的门到针时间（DNT）。
我们进行了一项前瞻性、观察性研究，时间为 2012 年至 2017 年，纳入接受 tPA 治疗的 AIS 患者。收集的数据包括性别、年龄、门到扫描时间、扫描到针时间和 DNT。值班神经科医生 08:00 至 20:00 现场值班，20:00 至 8:00 电话值班但不在现场。形成了三组：现场值班、非现场值班和非现场值班但有住院医生在场。
我们的样本包括 138 名患者。平均年龄为 69.7 岁，45.7%的患者为女性。96 名患者在现场值班期间入院，25 名在非现场值班期间入院，17 名在非现场-住院医生在场值班期间入院。现场和非现场值班期间入院的患者的 DNT 分别为 59 分钟和 72 分钟（P=.003）。现场、非现场和非现场-住院医生在场值班的 DNT 分别为 59、74 和 68 分钟（P=.001）；现场和非现场值班之间的 DNT 差异具有统计学意义。DNT 与白天（上午、下午或晚上）或工作日与周末无关。
当班神经科医生在激活中风代码时的现场或非现场值班状态会影响 DNT。住院医生在场可以缩短 DNT。
