An interdisciplinary approach to inhospital stroke improves stroke detection and treatment time.
Background Inhospital stroke (IHS) is associated with high morbidity and mortality, likely related to multiple factors, including delayed time to recognition, associated comorbidities, and initial care from non-stroke trained providers. We hypothesized that guided revision of a formalized 'stroke co...
| Publicado en: | Journal of NeuroInterventional Surgery Vol. 11; no. 11; pp. 1080 - 1086 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | protocol research tables/charts Journal Article |
| Publicado: |
BMJ Publishing Group
Nov2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139157371&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139157371 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17598478 AZVK jtl: Journal of NeuroInterventional Surgery issn: 17598478 maglogo: N pubinfo: dt: Nov2019 vid: 11 iid: 11 pid: 8280 pub: BMJ Publishing Group artinfo: ui: 139157371 139157371 139157371 10.1136/neurintsurg-2019-014890 139157371 ppf: 1080 ppct: 6 formats: tig: atl: An interdisciplinary approach to inhospital stroke improves stroke detection and treatment time. aug: au: Manners, Jody Khandker, Namir Barron, Adam Aziz, Yasmin Desai, Shashvat M. Morrow, Benjamin Delfyett, William T. Martin-Gill, Christian Shutter, Lori Jovin, Tudor G. Jadhav, Ashutosh P. affil: Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA sug: subj: Multidisciplinary Care Team Protocols Cerebral Ischemia Diagnosis Stroke Diagnosis Cerebral Ischemia Therapy Stroke Therapy Thrombolytic Therapy Thrombectomy Human Inpatients Time Factors Retrospective Design Communication Diagnostic Errors Prevention and Control Descriptive Statistics Patient Attitudes Reperfusion Multiple Regression Treatment Outcomes ab: Background Inhospital stroke (IHS) is associated with high morbidity and mortality, likely related to multiple factors, including delayed time to recognition, associated comorbidities, and initial care from non-stroke trained providers. We hypothesized that guided revision of a formalized 'stroke code' system can improve diagnosis and time to thrombolysis and thrombectomy. Methods IHS activations occurring at a comprehensive stroke center between 2013 and 2016 were retrospectively analyzed to guide revisions of an established stroke code protocol to improve provider communication and time to imaging, reduce stroke mimic rate, and improve the use of parallel processing. After protocol implementation, we prospectively collected data between 2016 and 2017 for comparison with the pre-implementation group, including diagnostic accuracy and relevant time points (code call to examination, examination to imaging, and imaging to intervention). We report descriptive statistics for comparison of patient characteristics and time metrics (time to imaging and reperfusion after IHS activation). Multivariable regression analysis was performed to identify independent predictors of stroke mimics and time metrics. Results There were 136 cases in the preimplementation group and 69 in the postimplementation group. A reduction in stroke mimics (52% vs 33%, P=0.01) occurred after protocol initiation. Mean time to imaging after stroke code call was 7.6 min shorter (P=0.026) and mean time from imaging to acute reperfusion therapy was 45.7 vs 19.8 min (P=0.05) in the pre- versus the post-implementation group. Conclusion Revision of an existing IHS protocol was associated with a lower rate of stroke mimics, and a shorter time to intravenous and intra-arterial intervention. pubtype: Academic Journal doctype: protocol research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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