Sarmiento Robert Joseph, Wagner Amanda, Sheriff Asif, Taralson Colleen, Moniz Nadine, Opsahl Jason, Jeerakathil Thomas, Buck Brian, Sevcik William, Shuaib Ashfaq, Kate Mahesh
Department of Medicine, University of Alberta, Edmonton, AB T6G2B7, Canada;
College of Medicine, University of Saskatchewan, Regina, SK S4S 0A2, Canada.
NeuroSci. 2024 Aug 22;5(3):291-300. doi: 10.3390/neurosci5030023. eCollection 2024 Sep.
The burden of simultaneous acute code stroke activation (ACSA) is not known. We aim to assess the effect of simultaneous ACSA on workflow metrics and home time at 90 days in patients undergoing reperfusion therapies in the emergency department. Simultaneous ACSA was defined as code activation within 60 min of the arrival of any patient receiving intravenous thrombolysis, within 150 min of the arrival of any patient receiving endovascular thrombectomy, within 45 min of the arrival of any patient receiving no reperfusion therapies (based on mean local door-to-needle and door-to-puncture times). Simultaneous ACSA was further graded as 1, 2 and 3. We assessed workflow metrics as door-to-CT (DTC) time, in minutes, and functional outcome as home time at 90 days. A total of 2605 patients were assessed as ACSA at a mean ± SD activations of 130.8 ± 17.1/month and 859 (33%) were simultaneous. Among all ACSA, 545 (20.9%) underwent acute reperfusion therapy with a mean age of 70.6 ± 14.2 years, 45.9% (n = 254) were female with a median (IQR) NIHSS of 13 (8-18). A total of 220 (40.4%) patients underwent simultaneous treatments. The median DTC time, in minutes, was prolonged in grade 3 simultaneous ACSA (18 (13, 28)) compared to non-simultaneous ACSA (15 (11, 21) β = 0.23, < 0.0001). There was no difference in the median home time at 90 days between the simultaneous (58, 0-84.5 days) and non-simultaneous (54, 0-85 days) patients. Simultaneous ACSA is frequent in patients receiving acute reperfusion therapies. An optimal workflow in high-volume centers may help mitigate the clinical and system burden associated with simultaneity.
同时发生急性卒中急救激活（ACSA）的负担尚不清楚。我们旨在评估同时发生的ACSA对急诊科接受再灌注治疗患者90天时工作流程指标和回家时间的影响。同时发生的ACSA定义为：在任何接受静脉溶栓治疗的患者到达后60分钟内、任何接受血管内血栓切除术的患者到达后150分钟内、任何未接受再灌注治疗的患者到达后45分钟内（基于平均当地门到针和门到穿刺时间）发生急救激活。同时发生的ACSA进一步分为1级、2级和3级。我们将工作流程指标评估为门到CT（DTC）时间（以分钟为单位），将功能结局评估为90天时的回家时间。共有2605例患者被评估为ACSA，平均激活次数为每月130.8±17.1次，其中859例（33%）为同时发生。在所有ACSA中，545例（20.9%）接受了急性再灌注治疗，平均年龄为70.6±14.2岁，45.9%（n = 254）为女性，美国国立卫生研究院卒中量表（NIHSS）中位数（四分位间距）为13（8 - 18）。共有220例（40.4%）患者接受了同时治疗。与非同时发生的ACSA（15（11，21）β = 0.23，< 0.0001）相比，3级同时发生的ACSA的DTC时间中位数（分钟）延长（18（13，28））。同时发生（58，0 - 84.5天）和非同时发生（54，0 - 85天）的患者在90天时的回家时间中位数没有差异。在接受急性再灌注治疗的患者中，同时发生ACSA的情况很常见。大容量中心的优化工作流程可能有助于减轻与同时发生相关的临床和系统负担。
