From the Department of Neurology, McGovern Medical School (A.L.C., R.B., A.J.-C., S.A.P, K.P., S.A.S.), University of Texas Health Science Center, Houston.
Department of Biostatistics and Data Science, School of Public Health (N.S., M.W., J.-M.Y.), University of Texas Health Science Center, Houston.
Stroke. 2020 May;51(5):1613-1615. doi: 10.1161/STROKEAHA.119.028626. Epub 2020 Apr 16.
Background and Purpose- Endovascular thrombectomy (ET) door-to-puncture time (DTPT) is a modifiable metric. One of the most important, yet time-consuming steps, is documentation of large vessel occlusion by computed tomography angiography (CTA). We hypothesized that obtaining CTA on board a Mobile Stroke Unit and direct alert of the ET team shortens DTPT by over 30 minutes. Methods- We compared DTPT between patients having CTA onboard the Mobile Stroke Unit then subsequent ET from September 2018 to November 2019 and patients in Mobile Stroke Unit from August 2014 to August 2018, when onboard CTA was not yet being used. We also correlated DTPT with change in National Institutes of Health Stroke Scale between baseline and 24 hours. Results- Median DTPT was 53.5 (95% CI, 35-67) minutes shorter with onboard CTA and direct ET team notification: 41 minutes (interquartile range, 30.0-63.5) versus 94.5 minutes (interquartile range, 69.8-117.3; <0.001). Median on-scene time was 31.5 minutes (interquartile range, 28.8-35.5) versus 27.0 minutes (interquartile range, 23.0-31.0) (<0.001). Shorter DTPT correlated with greater improvement of National Institutes of Health Stroke Scale (correlation=-0.2, =0.07). Conclusions- Prehospital Mobile Stroke Unit management including on-board CTA and ET team alert substantially shortens DTPT. Registration- URL: https://clinicaltrials.gov; Unique identifier: NCT02190500.
背景与目的-血管内血栓切除术（ET）门到穿刺时间（DTPT）是一个可改变的指标。其中最重要但最耗时的步骤之一是通过计算机断层血管造影（CTA）来记录大血管闭塞。我们假设在移动卒中单元上进行 CTA 并直接向 ET 团队发出警报可以将 DTPT 缩短 30 多分钟。方法-我们比较了 2018 年 9 月至 2019 年 11 月期间在移动卒中单元上进行 CTA 后进行随后 ET 的患者与 2014 年 8 月至 2018 年 8 月期间在移动卒中单元上未使用 CTA 时的患者的 DTPT。我们还将 DTPT 与基线和 24 小时之间的国立卫生研究院卒中量表的变化进行了相关性分析。结果-使用 onboard CTA 和直接通知 ET 团队时，中位 DTPT 缩短了 53.5 分钟（95%CI，35-67）：41 分钟（四分位距，30.0-63.5）与 94.5 分钟（四分位距，69.8-117.3；<0.001）。现场中位时间为 31.5 分钟（四分位距，28.8-35.5）与 27.0 分钟（四分位距，23.0-31.0）（<0.001）。较短的 DTPT 与国立卫生研究院卒中量表的改善程度更高相关（相关系数=-0.2，=0.07）。结论-包括 onboard CTA 和 ET 团队警报在内的移动卒中单元院前管理可显著缩短 DTPT。登记-网址：https://clinicaltrials.gov；唯一标识符：NCT02190500。
