Liang Xiao, Gao Wenhui, Xu Jiali, Saymuah Sara, Wang Xiaojie, Wang Jing, Zhao Wenbo, Xing Xiurong, Wang Changyuan, Liu Fangyan, Feng Lei, Li Sijie
Department of Emergency, Xuanwu Hospital Capital Medical University, Beijing, China.
Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
Evid Based Complement Alternat Med. 2022 Mar 3;2022:9199856. doi: 10.1155/2022/9199856. eCollection 2022.
This was a retrospective analysis in a general hospital emergency department in Beijing, China. 212 adult AIS patients treated with thrombolysis who failed to use EMSs were included. In addition to DNT, door-to-vein open time (DVT), door-to-blood sample deliver time (DBT), and 7-day NIHSS scores were evaluated.
137 (64.6%) patients were in the triage nurse-activated group and 75 (35.4%) patients were in the doctor-activated group. The DNT of the triage nurse-activated group was significantly reduced compared with the doctor-activated group (28 (26, 32.5) min vs. 30 (28, 40) min, =0.001). DNT less than 45 min was seen in 95.6% of patients in the triage nurse-activated group and 84% of patients in the doctor-activated group (=0.011, OR 3.972, 95% CI 1.375-11.477). In addition, DVT (7 (4, 10) min vs. 8 (5, 12) min, =0.025) and DBT (15 (13, 21) min vs. 19 (15, 26) min, =0.001) of the triage nurse-activated group were also shorter than those of the doctor-activated group ( < 0.05). The 7-day NIHSS scores were not statistically different between the two groups.
Triage nurse-activated urgent emergency evaluation could reduce the door-to-needle time, which provides a feasible opportunity to optimize the emergency department service for AIS patients who failed to use emergency medical services.
这是一项在中国北京一家综合医院急诊科进行的回顾性分析。纳入了212例接受溶栓治疗但未使用急救医疗服务的成年急性缺血性卒中（AIS）患者。除了评估门到针时间（DNT）外，还评估了门到静脉开通时间（DVT）、门到血样送检时间（DBT）和7天美国国立卫生研究院卒中量表（NIHSS）评分。
137例（64.6%）患者属于分诊护士启动组，75例（35.4%）患者属于医生启动组。分诊护士启动组的DNT与医生启动组相比显著缩短（28（26，32.5）分钟 vs. 30（28，40）分钟，P = 0.001）。分诊护士启动组95.6%的患者DNT小于45分钟，医生启动组84%的患者DNT小于45分钟（P = 0.011，比值比（OR）3.972，95%置信区间（CI）1.375 - 11.477）。此外，分诊护士启动组的DVT（7（4，10）分钟 vs. 8（5，12）分钟，P = 0.025）和DBT（15（13，21）分钟 vs. 19（15，26）分钟，P = 0.001）也短于医生启动组（P < 0.05）。两组的7天NIHSS评分无统计学差异。
分诊护士启动的紧急评估可缩短门到针时间，这为优化未使用急救医疗服务的AIS患者的急诊科服务提供了一个可行的机会。
