Servicio de Neurología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Servicio de Neurología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Neurologia (Engl Ed). 2022 Sep;37(7):543-549. doi: 10.1016/j.nrleng.2019.08.004. Epub 2021 Sep 17.
Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site.
We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present.
Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site-resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72 minutes, respectively (P = .003). DNTs were 59, 74, and 68 minutes (P = .001), respectively, for the on-site, off-site, and off-site-resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends.
DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT.
医院神经科值班经常在现场，但有些值班服务可能在现场外或混合。静脉注射组织型纤溶酶原激活剂（tPA）是急性缺血性脑卒中（AIS）主要再灌注治疗之一。本研究评估了值班神经科医生在现场或不在现场时的门到针时间（DNT）。
我们进行了一项前瞻性、观察性研究，时间为 2012 年至 2017 年，纳入接受 tPA 治疗的 AIS 患者。收集数据包括性别、年龄、门到扫描时间、扫描到针时间和 DNT。值班神经科医生在 08:00 至 20:00 之间在现场，20:00 至 08:00 之间在现场外值班。形成三组：现场、现场外和现场外有住院医生。
我们的样本包括 138 例患者。平均年龄为 69.7 岁，45.7%的患者为女性。96 例患者在现场值班期间入院，25 例在现场外值班期间入院，17 例在现场外有住院医生值班期间入院。在现场和现场外值班期间入院的患者的 DNT 分别为 59 和 72 分钟（P=0.003）。现场、现场外和现场外有住院医生值班的 DNT 分别为 59、74 和 68 分钟（P=0.001），现场和现场外值班之间的 DNT 差异有统计学意义。根据一天中的时间（上午、下午或晚上）或工作日和周末，DNT 没有差异。
DNT 受到值班神经科医生在代码中风激活时是否在现场或现场外的影响。有神经科住院医生在场可以缩短 DNT。
