Jeong Young Ju, Kim Ki Hong, Park Jeong Ho, Ro Young Sun, Song Kyoung Jun, Shin Sang Do
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
J Emerg Med. 2025 Jul;74:77-85. doi: 10.1016/j.jemermed.2025.02.005. Epub 2025 Feb 6.
Acute stroke is a major health burden and prompt management at the emergency department (ED) is crucial for favorable outcomes.
This study aimed to evaluate the associations between prehospital notification to the ED and time to management in acute ischemic stroke patients.
Patients with acute ischemic stroke who visited a thrombolysis-available ED through an emergency medical service (EMS) from July 2020 to December 2021 were included. The main exposure was prenotification by EMS personnel. The primary outcome was the time to management in acute stroke care metrics in ED-stroke critical pathway (CP) activation, brain radiographic evaluation, intravenous thrombolysis, mechanical thrombectomy, and stroke unit admission. Multivariable linear regression analysis was conducted.
A total of 1107 acute ischemic stroke patients were included. The time to management was shorter in the prenotification group than in the control group; CP activation was 10 vs. 13.5 min, brain radiographic evaluation was 27 vs. 35 min, intravenous thrombolysis was 50.5 vs. 56.5 min, mechanical thrombectomy was 126.5 vs. 151.0 min, and stroke unit admission was 270.5 vs. 295.5 min. The prenotification group had a greater probability of a shorter time to management: Estimate (95% confidence intervals) was -15.7 min (-22.7 to -8.8) for CP activation, -13.8 min (-19.9 to -7.6) for brain radiographic evaluation, -20.9 min (-32.6 to -9.2) for intravenous thrombolysis, -81.6 min (-149.0 to -14.2) for mechanical thrombectomy, and -20.8 (-66.7 to -25.1) for stroke unit admission.
In acute ischemic stroke patients, prehospital prenotification was found to be associated with a shorter time to management.
急性中风是一项重大的健康负担，在急诊科（ED）进行及时处理对于取得良好预后至关重要。
本研究旨在评估急性缺血性中风患者的院前通知急诊科与处理时间之间的关联。
纳入2020年7月至2021年12月期间通过紧急医疗服务（EMS）前往可进行溶栓治疗的急诊科就诊的急性缺血性中风患者。主要暴露因素为EMS人员的预先通知。主要结局是在急诊科中风关键路径（CP）激活、脑部影像学评估、静脉溶栓、机械取栓和入住卒中单元等急性中风护理指标中的处理时间。进行了多变量线性回归分析。
共纳入1107例急性缺血性中风患者。预先通知组的处理时间比对照组短；CP激活时间分别为10分钟和13.5分钟，脑部影像学评估时间分别为27分钟和35分钟，静脉溶栓时间分别为50.5分钟和56.5分钟，机械取栓时间分别为126.5分钟和151.0分钟，入住卒中单元时间分别为270.5分钟和295.5分钟。预先通知组处理时间较短的可能性更大：CP激活的估计值（95%置信区间）为-15.7分钟（-22.7至-8.8），脑部影像学评估为-13.8分钟（-19.9至-7.6），静脉溶栓为-20.9分钟（-32.6至-9.2），机械取栓为-81.6分钟（-149.0至-14.2），入住卒中单元为-20.8（-66.7至-25.1）。
在急性缺血性中风患者中，发现院前预先通知与较短的处理时间相关。
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