Vicente-Pascual M, Quilez A, Gil M P, González-Mingot C, Vázquez-Justes D, Mauri-Capdevila G, Sanahuja J, García-Vázquez C, Purroy F
Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España.
Grupo de Neurociencias Clínicas, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, España.
Neurologia (Engl Ed). 2020 Dec 21. doi: 10.1016/j.nrl.2020.10.014.
Door-to-needle time (DNT) has been established as the main indicator in code stroke protocols. According to the 2018 guidelines of the American Heart Association/American Stroke Association, DNT should be less than 45minutes; therefore, effective and revised pre-admission and in-hospital protocols are required.
We analysed organisational changes made between 2011 and 2019 and their influence on DNT and the clinical progression of patients treated with fibrinolysis. We collected data from our centre, stored and monitored under the Master Plan for Cerebrovascular Disease of the regional government of Catalonia. Among other measures, we analysed the differences between years and differences derived from the implementation of the Helsinki model.
The study included 447 patients, and we observed significant differences in DNT between different years. Pre-hospital code stroke activation, recorded in 315 cases (70.5%), reduced DNT by a median of 14minutes. However, the linear regression model only showed an inversely proportional relationship between the adoption of the Helsinki code stroke model and DNT (beta coefficient, -0.42; P<.001). The removal of vascular neurologists after the adoption of the Helsinki model increased DNT and the 90-day mortality rate.
DNT is influenced by the organisational model. In our sample, the application of the Helsinki model, the role of the lead vascular neurologist, and notification of code stroke by pre-hospital emergency services are key factors for the reduction of DNT and the clinical improvement of the patient.
门到针时间（DNT）已被确立为卒中急救流程的主要指标。根据美国心脏协会/美国卒中协会2018年指南，DNT应小于45分钟；因此，需要有效的、经过修订的院前和院内流程。
我们分析了2011年至2019年间所做的组织变革及其对DNT和接受纤溶治疗患者临床病程的影响。我们从我们中心收集数据，这些数据在加泰罗尼亚地区政府的脑血管疾病总体规划下存储和监测。在其他措施中，我们分析了不同年份之间的差异以及因实施赫尔辛基模式而产生的差异。
该研究纳入了447例患者，我们观察到不同年份之间DNT存在显著差异。315例（70.5%）记录了院前卒中急救激活情况，DNT中位数减少了14分钟。然而，线性回归模型仅显示采用赫尔辛基卒中模式与DNT之间呈反比关系（β系数，-0.42；P<0.001）。采用赫尔辛基模式后血管神经科医生的撤离增加了DNT和90天死亡率。
DNT受组织模式影响。在我们的样本中，赫尔辛基模式的应用、血管神经科主任的作用以及院前急救服务对卒中急救的通报是降低DNT和改善患者临床状况的关键因素。
