Sección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Sección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Neurologia (Engl Ed). 2021 Sep;36(7):487-494. doi: 10.1016/j.nrleng.2018.03.009. Epub 2020 Mar 18.
Recent analyses emphasise that The Benchmark Stroke Door-to-Needle Time (DNT) should be 30min. This study aimed to determine if a new in-hospital IVT protocol is effective in reducing door-to-needle time and correcting previously identified factors associated with delays.
In 2014, we gradually introduced a series of measures aimed to reduce door-to-needle time for patients receiving IVT, and compared it before (2009-2012) and after (2014-2017) the new protocol was introduced.
The sample included 239 patients before and 222 after the introduction of the protocol. Median overall door-to-needle time was 27min after the protocol was fully implemented (a 48% reduction on previous door-to-needle time [52min], P<.001)]. Median door-to-needle time was lower when pre-hospital code stroke was activated (22min). We observed a 26-min reduction in the median time from onset to treatment (P<.001). After the protocol was implemented, the "3-hour-effect" did not affect door-to-needle time (P=.98). Computed tomography angiography studies performed before IVT were associated with increased door-to-needle time (P<.001); however, the test was performed after IVT was started in most cases.
Hospital reorganisation and multidisciplinary collaboration brought median door-to-needle time below 30min and corrected previously identified delay factors. Furthermore, overall time from onset to treatment was also reduced and more stroke patients were treated within 90min of symptom onset.
最近的分析强调，Benchmark 卒中从门到针的时间（DNT）应在 30 分钟以内。本研究旨在确定新的院内 IVT 方案是否能有效缩短门到针的时间，并纠正以前发现的与延迟相关的因素。
2014 年，我们逐步引入了一系列旨在缩短接受 IVT 治疗的患者门到针时间的措施，并比较了新方案引入前后（2009-2012 年和 2014-2017 年）的情况。
样本包括方案引入前的 239 例患者和引入后的 222 例患者。在完全实施方案后，总门到针时间中位数为 27 分钟（与之前的门到针时间相比减少了 48%[52 分钟]，P<.001）。当院前卒中代码激活时，门到针时间中位数较低（22 分钟）。我们观察到从发病到治疗的中位数时间减少了 26 分钟（P<.001）。在方案实施后，“3 小时效应”并不影响门到针时间（P=.98）。在开始 IVT 之前进行的 CT 血管造影研究与门到针时间延长有关（P<.001）；然而，在大多数情况下，该检查是在开始 IVT 后进行的。
医院组织调整和多学科合作将门到针时间中位数缩短到 30 分钟以下，并纠正了以前发现的延迟因素。此外，从发病到治疗的总时间也缩短了，更多的卒中患者在症状发作后 90 分钟内得到了治疗。
