Department of Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia.
Department of Medicine, Monash Health, Melbourne, Victoria, Australia.
Intern Med J. 2021 Jun;51(6):905-909. doi: 10.1111/imj.14843.
Time to successful reperfusion is a critical prognostic factor for acute ischaemic stroke. Mechanical thrombectomy has become the gold standard treatment for emergent large vessel occlusion stroke. The timely delivery of this highly specialised procedure to patients outside of metropolitan centres presents a dilemma of inequity, with limited workflow data hindering benchmarking and service optimisation.
To analyse key stroke treatment time parameters from a primary stroke centre existing in a regional centre within a hub-and-spoke delivery model in Victoria, Australia.
Retrospective cohort study of patients transferred from a regional primary stroke centre to a metropolitan comprehensive stroke centre for mechanical thrombectomy between July 2016 and December 2018. Time workflow analysis was conducted from symptom onset to primary stroke centre departure.
A total of 55 patients was included in this study with an average age of 70.2 years. Median National Institutes of Health Stroke Scale score on admission was 13 (interquartile range (IQR) 7-17). Median pre-hospital time was 68 min (IQR 56-137) and median door-in-door-out time was 120.5 min (IQR 98-150), constituting 36.1% and 63.9% of total median time from symptom onset to primary stroke centre departure (188.5 min) respectively. There were no significant differences across observed cohort characteristics under linear regression analysis.
Protracted pre-hospital and primary stroke centre workflow times can delay effective treatment for patients with acute ischaemic stroke in regional areas. A systems-level approach to streamlining processes in these key areas is required to bridge this inequity in best practice care.
对于急性缺血性脑卒中，达到再灌注的时间是一个关键的预后因素。机械取栓已成为治疗大血管闭塞性脑卒中的金标准。在大都市中心以外的地区，将这种高度专业化的治疗及时提供给患者，存在着不平等的困境，由于有限的工作流程数据，妨碍了基准测试和服务优化。
分析澳大利亚维多利亚州一个轮辐式输送模式下的区域中心内的初级卒中中心的关键卒中治疗时间参数。
对 2016 年 7 月至 2018 年 12 月期间从区域初级卒中中心转至大都市综合卒中中心进行机械取栓的患者进行回顾性队列研究。对症状发作至初级卒中中心出发的时间流程进行分析。
本研究共纳入 55 例患者，平均年龄为 70.2 岁。入院时的美国国立卫生研究院卒中量表（NIHSS）评分为 13 分（中位数[IQR]7-17）。中位院前时间为 68 分钟（IQR 56-137），中位门到门时间为 120.5 分钟（IQR 98-150），分别占从症状发作至初级卒中中心出发的总中位数时间（188.5 分钟）的 36.1%和 63.9%。在线性回归分析中，各观察队列特征之间没有显著差异。
在区域内，延长的院前和初级卒中中心工作流程时间可能会延迟急性缺血性脑卒中患者的有效治疗。需要从系统层面入手，简化这些关键领域的流程，以弥合最佳实践护理方面的这种不平等。
