Bhatt Nirav R, Martin-Gill Christian, Al-Qudah Abdullah, Dermigny Katharine, Doheim Mohamed F, Rios Rocha Lucas, Sultany Abdullah, Kakamyradov Guvanch, Rocha Marcelo, Starr Matthew, Patterson Rebecca, Al-Bayati Alhamza R, Guyette Francis X, Nogueira Raul G
Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
UPMC Stroke Institute, Pittsburgh, PA, USA.
J Neurointerv Surg. 2024 Sep 18. doi: 10.1136/jnis-2024-022122.
We sought to identify systemic factors influencing door-to-puncture times (DTP) among patients with pre-arrival notifications presenting directly to a comprehensive stroke center (CSC) and undergoing emergent mechanical thrombectomy (MT).
In this retrospective analysis of a prospectively maintained registry of acute ischemic stroke (AIS) patients undergoing MT at two CSCs between January 2021 and October 2023, we included consecutive AIS patients presenting directly to the CSC with pre-arrival notifications via emergency medical services (EMS) and who underwent emergent MT. We excluded patients with known confounders to DTP and divided this cohort into two groups: DTP ≤75 min and >75 min. We used variables with P value <0.2 in the univariate analysis to build a binary logistic regression model to identify their association with DTP >75 min, adjusting for door-to-CT time.
Of 900 patients, 605 were inter-facility transfers, 89 were excluded due to known confounders/missing prehospital notifications, leaving 206 qualifying patients. On multivariable analysis, not meeting American Heart Association (AHA) level 1 criteria (adjusted OR (aOR) 3.04, 95% CI 1.62 to 5.82, P<0.001), lack of Prehospital Stroke Severity Scale (PSSS) acquisition (aOR 2.2, 95% CI 1.19 to 4.11, P=0.01), and presentation after-hours (aOR 2.27, 95% CI 1.23 to 4.28, P=0.01) were associated with >75 min DTP times. Most patients (62.3%) had no clearly documented reasons for delay in MT, whereas 25.8% of delays were attributed to prolonged medical decision-making.
Arrival outside business hours, not meeting AHA level 1 criteria, and lack of PSSS acquisition by EMS were associated with prolonged DTP. Impacting modifiable factors such as prehospital assessment of stroke severity is an optimal target for quality improvement.
我们试图确定在直接前往综合卒中中心（CSC）并接受紧急机械取栓（MT）的有到达前通知的患者中，影响门到穿刺时间（DTP）的全身因素。
在对2021年1月至2023年10月期间在两个CSC接受MT的急性缺血性卒中（AIS）患者的前瞻性维护登记册进行的这项回顾性分析中，我们纳入了通过紧急医疗服务（EMS）直接前往CSC且有到达前通知并接受紧急MT的连续AIS患者。我们排除了已知会混淆DTP的患者，并将该队列分为两组：DTP≤75分钟和>75分钟。我们在单变量分析中使用P值<0.2的变量来建立二元逻辑回归模型，以确定它们与DTP>75分钟的关联，并调整门到CT时间。
在900名患者中，605名是机构间转运患者，89名因已知的混杂因素/缺少院前通知而被排除，剩下206名符合条件的患者。在多变量分析中，未达到美国心脏协会（AHA）1级标准（调整后的OR（aOR）为3.04，95%CI为1.62至5.82，P<0.001）、未获取院前卒中严重程度量表（PSSS）（aOR为2.2，95%CI为1.19至4.11，P=0.01）以及非工作时间就诊（aOR为2.27，95%CI为1.23至4.28，P=0.01）与DTP时间>75分钟相关。大多数患者（62.3%）没有明确记录的MT延迟原因；而25.8%的延迟归因于延长的医疗决策时间。
非工作时间到达、未达到AHA 1级标准以及EMS未获取PSSS与延长的DTP相关。影响可改变的因素，如院前卒中严重程度评估，是质量改进的最佳目标。
