Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Neurologist. 2021 Nov 30;27(2):61-64. doi: 10.1097/NRL.0000000000000372.
The purpose of this study is to share our experience in changing hospital strategies to achieve rapid thrombolysis in acute ischemic stroke (AIS) patients in 2 university stroke centers. Rapid reperfusion by shortening door to needle time (DTN) reduces morbidity and mortality for patients with AIS. Our aim is to evaluate the effect of applying certain logistic strategies to reduce DTN for thrombolysis and its impact on clinical outcome.
In this retrospective registry-based observational study from the SITS-ISTR Dataset, we studied AIS patients admitted to 2 stroke centers in Ain Shams University over 3 successive years from 2016 till 2018. We analyzed change of DTN and outcome at 3 months by modified Rankin scale over these 3 years.
By the end of the 3 year period there was a 6.1% increase in number of patients receiving thrombolysis. There was a significant decrease of median DTN by 41%, and increase in percentage of patients receiving recombinant tissue plasminogen activator within a shorter DTN. Also, the number of patients with a favorable outcome (modified Rankin scale≤2) increased by 23.3%. There was insignificant difference regarding mortality rate.
Applying a goal-directed corrective strategy to improve quality of service can, in a short time, reduce DTN and improve patient outcome.
本研究旨在分享我们在 2 所大学卒中中心改变医院策略以实现急性缺血性卒中（AIS）患者快速溶栓的经验。通过缩短门到针时间（DTN）实现快速再灌注可降低 AIS 患者的发病率和死亡率。我们的目的是评估应用某些后勤策略来减少溶栓的 DTN 及其对临床结果的影响。
本研究是一项回顾性基于 SITS-ISTR 数据集的观察性研究，纳入了 2016 年至 2018 年期间在艾因夏姆斯大学的 2 所卒中中心连续 3 年收治的 AIS 患者。我们分析了这 3 年中 DTN 和 3 个月时改良 Rankin 量表（mRS）评分的变化。
在 3 年期末，接受溶栓治疗的患者数量增加了 6.1%。中位 DTN 显著缩短了 41%，并且在较短的 DTN 内接受重组组织型纤溶酶原激活剂治疗的患者比例增加。此外，预后良好（mRS 评分≤2）的患者数量增加了 23.3%。死亡率无显著差异。
应用以目标为导向的纠正策略来提高服务质量，可以在短时间内缩短 DTN 并改善患者的预后。
