Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW, Australia.
South Western Sydney Clinical School, UNSW Medicine, University of New South Wales (UNSW, Sydney, NSW, Australia.
Acta Neurol Scand. 2021 Oct;144(4):418-432. doi: 10.1111/ane.13476. Epub 2021 Jun 8.
The value of in-hospital systems-based interventions in streamlining treatment delays associated with reperfusion therapy delivery in acute ischaemic stroke (AIS), in the emergency department (ED), is poorly understood. This systematic review and meta-analysis aimed to assess and quantify the value of in-hospital systems-based interventions in streamlining reperfusion therapy delivery following AIS.
MATERIAL & METHODS: Articles from the following databases were retrieved: Medline, Embase and Cochrane Central Register of Controlled Trials. The primary endpoint was in-hospital time metrics between the intervention and control group. The secondary endpoint included the rate of good functional outcome at 90 days.
393 Systems intervention studies published after 2015 were screened, and 231 full articles were then read. In total, 35 studies with 35,815 patients were included in the final systematic review and 26 studies with 7,089 patients were used in the meta-analysis. The greatest time reductions from in-hospital system interventions were achieved in door-to-needle (DTN) time (SMD: -2.696, 95% CI: -2.976, -2.416, z = 3.03, p = 0.002). Systems interventions were also associated with a statistically significant improvement in mortality (RR: 0.25, 95% CI: 0.18, 0.38), rate of symptomatic intracerebral haemorrhage (RR: 0.07, 95% CI: 0.04, 0.1) and ≤60-minute reperfusion rates (RR: 0.63, 95% CI: 0.51, 0.79).
The use of in-hospital workflow optimization is imperative to expedite reperfusion therapy delivery and improving patient outcomes. To reduce the morbidity and mortality of stroke globally, in-hospital workflow guidelines should be adhered to and incorporated including the optimal elements identified in this study.
在急性缺血性脑卒中（AIS）的急诊科（ED）中，基于院内系统的干预措施在简化再灌注治疗方面的价值尚未得到充分理解。本系统评价和荟萃分析旨在评估和量化基于院内系统的干预措施在简化 AIS 后再灌注治疗方面的价值。
从以下数据库中检索文章：Medline、Embase 和 Cochrane 对照试验中心注册库。主要终点是干预组和对照组之间的院内时间指标。次要终点包括 90 天的良好功能结局率。
筛选了 2015 年后发表的 393 项系统干预研究，然后阅读了 231 篇全文。最终有 35 项研究（共 35815 例患者）纳入了最终的系统评价，26 项研究（共 7089 例患者）纳入了荟萃分析。从院内系统干预中获得的最大时间缩短是在门到针时间（SMD：-2.696，95%CI：-2.976，-2.416，z = 3.03，p = 0.002）。系统干预也与死亡率的统计学显著改善相关（RR：0.25，95%CI：0.18，0.38）、症状性颅内出血发生率（RR：0.07，95%CI：0.04，0.1）和≤60 分钟再灌注率（RR：0.63，95%CI：0.51，0.79）。
使用院内工作流程优化对于加快再灌注治疗的实施和改善患者结局至关重要。为了降低全球范围内的中风发病率和死亡率，应遵守并纳入院内工作流程指南，包括本研究中确定的最佳要素。
