The First People's Hospital of Huaihua, Huaihua City, China.
Poisoning Research Laboratory, Institue of Emergency Medicine, Hunan Provincial People's Hospital, The First Affiliate Hospital of Hunan Normal University, Changsha City, China.
Am J Emerg Med. 2023 Jul;69:147-153. doi: 10.1016/j.ajem.2023.04.008. Epub 2023 Apr 11.
Door-to-needle time (DNT) is a critical consideration in emergency management of acute ischemic stroke (AIS). Deficiencies in the widely applied standard hospital workflow process, based on international guidelines, impede rapid treatment of AIS patients. We developed an in-hospital stroke system to reduce DNT and optimize hospitals' emergency procedures.
To investigate the effect of the in-hospital stroke system on the hospital workflow for AIS patients.
We performed a retrospective study on AIS patients between June 2017 and December 2021. AIS cases were assigned to a pre-intervention group (before the in-hospital stroke system was established) and a post-intervention group (after the system's establishment). We compared the two groups' demographic features, clinical characteristics, treatments and outcomes, and time metrics data.
We analyzed 1031 cases, comprising 474 and 557 cases in the pre-intervention and post-intervention groups, respectively. Baseline data were similar for both groups. Significantly more patients in the post-intervention group (41.11%) were treated with intravenous thrombolysis (IVT) or endovascular therapy (ET) compared with those in the pre-intervention group (8.65%) (p < 0.001). DNT was markedly improved (decreasing from 118 (80.5-137) min to 26 (21-38) min among patients in the post-intervention group treated with IVT or bridging ET. Consequently, a much higher proportion of these patients (92.64%) received IVT within 60 min compared with those in the pre-intervention group (17.39%) (p < 0.001). Consequently, their hospital stays were shorter (8 [6-11] days vs. 10 [8-12] days for the pre-intervention group; p < 0.001), and they showed improved National Institutes of Health Stroke Scale (NIHSS) scores at discharge (-2 [-5-0] vs. -1 [-2-0], p < 0.001).
DNT was significantly reduced following implementation of the in-hospital stroke system, which contributed to improved patient outcomes measured by the length of hospital stay and NIHSS scores.
门到针时间（DNT）是急性缺血性脑卒中（AIS）急救管理的一个关键考虑因素。基于国际指南的广泛应用的标准医院工作流程存在缺陷，阻碍了 AIS 患者的快速治疗。我们开发了一种院内脑卒中系统，以缩短 DNT 并优化医院的急救程序。
调查院内脑卒中系统对 AIS 患者医院工作流程的影响。
我们对 2017 年 6 月至 2021 年 12 月期间的 AIS 患者进行了回顾性研究。将 AIS 病例分为干预前组（在建立院内脑卒中系统之前）和干预后组（在系统建立之后）。我们比较了两组的人口统计学特征、临床特征、治疗和结局以及时间指标数据。
共分析了 1031 例患者，其中干预前组和干预后组分别为 474 例和 557 例。两组的基线数据相似。干预后组（41.11%）接受静脉溶栓（IVT）或血管内治疗（ET）的患者明显多于干预前组（8.65%）（p<0.001）。DNT 明显改善（接受 IVT 或桥接 ET 的患者从干预前组的 118（80.5-137）min 降至 26（21-38）min）。因此，这些患者中有更高比例（92.64%）在 60min 内接受 IVT，而干预前组为 17.39%（p<0.001）。因此，他们的住院时间更短（干预前组为 8[6-11]天，干预后组为 10[8-12]天；p<0.001），出院时的国立卫生研究院卒中量表（NIHSS）评分更高（-2[-5-0]分比-1[-2-0]分，p<0.001）。
实施院内脑卒中系统后，DNT 显著缩短，这有助于通过住院时间和 NIHSS 评分来改善患者的结局。
