Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Sección de Neurointervencionismo, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España.
Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
Neurologia (Engl Ed). 2023 Apr;38(3):141-149. doi: 10.1016/j.nrleng.2020.07.023.
Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital.
Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol.
The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20minutes (P<.001).
The measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard.
时间仍然是急性缺血性脑卒中再灌注治疗的一个基本变量。尽管临床指南提出了建议，但只有大约三分之一的这些患者在 60 分钟内接受溶栓治疗。在这项研究中，我们描述了我们在实施急性缺血性脑卒中患者特定方案方面的经验，并评估了该方案对我们医院门到针时间的影响。
2015 年底逐步实施了措施，以缩短脑卒中管理时间并优化急性缺血性脑卒中患者的护理；这些措施包括创建一个特定的神经血管护理值班团队。我们比较了引入方案前后（2013-2015 年和 2017-2019 年）的脑卒中管理时间。
该研究包括 182 例在实施方案前接受治疗的患者和 249 例在实施方案后接受治疗的患者。一旦所有措施都生效，总体中位数门到针时间为 45 分钟（与实施前的 74 分钟相比，减少了 39%；P<.001），73.5%的患者在 60 分钟内接受治疗（增加了 47%；P<.001）。总治疗时间（发病到针时间）中位数减少了 20 分钟（P<.001）。
我们方案中包含的措施显著且持续地缩短了门到针时间，但仍有改进的空间。为监测结果和持续改进而建立的机制将使我们在这方面取得进一步的进展。
