Acute ischemic stroke, door to needle time, stroke code
Citation Information :
Gurav S, Zirpe K, Wadia R, Naniwadekar A, Mohopatra S, Nimavat B, Surywanshi P. Impact of “Stroke Code”-Rapid response team: An attempt to improve intravenous thrombolysis rate and to shorten Door-to-Needle time in acute ischemic stroke. Indian J Crit Care Med 2018; 22 (4):243-248.
Objective: “Stroke code” (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient.
Materials and Methods: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of “SC” (post-SC era) were analyzed (2015–2016) and compared with the retrospective data of patients treated in the “pre-SC era.” Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated. The severity of stroke was calculated using the National Institutes of Health Stroke Score (NIHSS) before and after treatment.
Results: Patients presented with stroke symptoms in pre- and post-SC era (695 vs. 610) and, out of these, patients who came in window period constituted 148 (21%) and 210 (34%), respectively. Patients thrombolyzed in pre- and post-SC era were 44 (29.7%) and 65 (44.52%), respectively. Average DTN time was 104.95 min in pre-SC era and reduced to 67.28 min (P < 0.001) post-SC implementation. Percentage of patients thrombolyzed within DTN time ≤60 min in pre-SC era and SC era was 15.90% and 55.38%, respectively.
Conclusion: Implementation of SC helped us to increase thrombolysis rate in AIS and decrease DTN time.
Paramasivam S. Current trends in the management of acute ischemic stroke. Neurol India 2015;63:665-72.
Kalkonde YV, Deshmukh MD, Sahane V, Puthran J, Kakarmath S, Agavane V, et al. Stroke is the leading cause of death in rural Gadchiroli, India: A Prospective community-based study. Stroke 2015;46:1764-8.
Murthy JM. Thrombolysis for stroke in India: Miles to go. Neurol India 2007;55:3-5.
Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke 2013;15:128-34.
Truelsen T, Begg S, Mathers C. The Global Burden of Cerebrovascular Disease. Available from: http://www.WHO statistics:cerebrovascular disease stroke pdf. [Last accessed on 2017 Aug].
Jin H, Zhu S, Wei JW, Wang J, Liu M, Wu Y, et al. Factors associated with prehospital delays in the presentation of acute stroke in Urban China. Stroke 2012;43:362-70.
Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV, et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: Patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011;123:750-8.
Gomez CR, Malkoff MD, Sauer CM, Tulyapronchote R, Burch CM, Banet GA, et al. Code stroke. An attempt to shorten inhospital therapeutic delays. Stroke 1994;25:1920-3.
Gurav SK, Zirpe KG, Wadia RS, Pathak MK, Deshmukh AM, Sonawane RV, et al. Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center. Indian J Crit Care Med 2015;19:265-9.
Meretoja A, Kaste M. Pre- and in-hospital intersection of stroke care. Ann N Y Acad Sci 2012;1268:145-51.
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7.
Jauch EC, Saver JL, Adams HP Jr., Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
Kamal N, Sheng S, Xian Y, Matsouaka R, Hill MD, Bhatt DL, et al. Delays in door-to-needle times and their impact on treatment time and outcomes in get with the guidelines-stroke. Stroke 2017;48:946-54.
Padma MV, Singh MB, Bhatia R, Srivastava A, Tripathi M, Shukla G, et al. Hyperacute thrombolysis with IV rtPA of acute ischemic stroke: Efficacy and safety profile of 54 patients at a tertiary referral center in a developing country. Neurol India 2007;55:46-9.
Ringelstein EB, Chamorro A, Kaste M, Langhorne P, Leys D, Lyrer P, et al. European stroke organisation recommendations to establish a stroke unit and stroke center. Stroke 2013;44:828-40.
Olson DM, Cox M, Constable M, Britz GW, Lin CB, Zimmer LO, et al. Development and initial testing of the stroke rapid-treatment readiness tool. J Neurosci Nurs 2014;46:267-73.
Chen CH, Tang SC, Tsai LK, Hsieh MJ, Yeh SJ, Huang KY, et al. Stroke code improves intravenous thrombolysis administration in acute ischemic stroke. PLoS One 2014;9:e104862.
Sadeghi-Hokmabadi E, Taheraghdam A, Hashemilar M, Rikhtegar R, Mehrvar K, Mehrara M, et al. Simple in-hospital interventions to reduce door-to-CT time in acute stroke. Int J Vasc Med 2016;2016:1656212.
Paolini S, Burdine J, Verenes M, Webster J, Faber T, Graham CB, et al. Rapid short MRI sequence useful in eliminating stroke mimics among acute stroke patients considered for intravenous thrombolysis. J Neurol Disord 2013;1:137.
Sauser-Zachrison K, Shen E, Sangha N, Ajani Z, Neil WP, Gould MK, et al. Safe and effective implementation of telestroke in a US community hospital setting. Perm J 2016;20:11-5.
Fonarow GC, Zhao X, Smith EE, Saver JL, Reeves MJ, Bhatt DL, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014;311:1632-40.
Kim JT, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC, et al. Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5-hour time-benefit curve in the national United States get with the guidelines-stroke population. Circulation 2017;135:128-39.