Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Helle Klingenberg Iversen³  Freddy K Lippert¹  Søren Viereck¹  Lene Michelsen³  Morten Andresen²  Sofie Amalie Simonsen³ 

[1] Emergency Medical Services, Copenhagen, Capital Region of Denmark, Telegrafvej 5, Ballerup 2750, Denmark;Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen East 2100, Denmark;Glostrup Stroke Centre, Department of Neurology, Glostrup Hospital, Copenhagen University Hospital, Nordre ringvej 57, Glostrup 2600, Denmark

关键词: Emergency treatment of stroke;    Thrombolysis;    Logistics;    Emergency medical services;    Pre-hospital delay;    Acute cerebral infarction;    Stroke;   

Others  :  1151688
DOI  :  10.1186/s13049-014-0065-z

 received in 2014-05-23, accepted in 2014-10-22,  发布年份 2014

【 摘 要 】

Background

Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.

Methods

We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch of the ambulance to arrival at the scene, on-scene time and transport time to the hospital¿in total, alarm-to-door time. In addition, we noted baseline characteristics.

Results

We reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33¿52), of which 18 (12¿24) minutes were spent on scene. Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001). In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001).

Conclusions

This study shows an unchanged alarm-to-door time of 41 minutes over a five-year period. Response time, but not total alarm-to-door time, was reduced during the five years. On-scene time constituted nearly half of the total alarm-to-door time and is thus a point of focus for improvement.

【 授权许可】

   
2014 Simonsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1][http:/ / www.dsfa.dk/ wp/ wpcontent/ uploads/ Refprogram-for-behandling-af-patien ter-med-apoplekis-final.pdf] webcite Danish Stroke Society: Reference Program for Treating Patients with Stroke. Copenhagen; 2009. .
• [2]Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, Kummer von R, Wahlgren N, Toni D: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. N Engl J Med 2008, 359:1317-1329.
• [3]Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S: Prehospital and Emergency Department Delays After Acute Stroke : The Genentech Stroke Presentation Survey. Stroke 2000, 31:2585-2590.
• [4]Lacy CR, Suh DC, Bueno M, Kostis JB: Delay in Presentation and Evaluation for Acute Stroke : Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke 2001, 32:63-69.
• [5]Turan TN, Hertzberg V, Weiss P, McClellan W, Presley R, Krompf K, Karp H, Frankel MR: Clinical Characteristics of Patients With Early Hospital Arrival After Stroke Symptom Onset. J Stroke Cerebrovasc Dis 2005, 14:272-277.
• [6]Palomeras E, Fossas P, Quintana M, Monteis R, Sebastián M, Fábregas C, Ciurana A, Ribó M, Cano A, Sanz P, Floriach M, Álvarez-Sabín J: Emergency perception and other variables associated with extra-hospital delay in stroke patients in the Maresme region (Spain). Eur J Neurol 2008, 15:329-335.
• [7]Faiz KW, Sundseth A, Thommessen B, Rønning OM: Prehospital delay in acute stroke and TIA. J Emerg Med 2013, 30:669-674.
• [8]Hesselfeldt R, Gyllenborg J, Steinmetz J, Do HQ, Hejselbaek J, Rasmussen LS: Is air transport of stroke patients faster than ground transport? A prospective controlled observational study. J Emerg Med 2014, 31:268-272.
• [9]Keskin OZ, Kalemo gbreve lu M, Ulusoy RE: A Clinic Investigation into Prehospital and Emergency Department Delays in Acute Stroke Care. Med Princ Pract 2005, 14:408-412.
• [10]Hong ES, Kim SH, Kim WY, Ahn R, Hong JS: Factors associated with prehospital delay in acute stroke. J Emerg Med 2011, 28:790-793.
• [11]Puolakka T, Väyrynen T, Häppölä O, Soinne L, Kuisma M, Lindsberg PJ: Sequential Analysis of Pretreatment Delays In Stroke Thrombolysis. Acad Emerg Med 2010, 17:965-969.
• [12]Quain DA, Parsons MW, Loudfoot AR, Spratt NJ, Evans MK, Russell ML, Royan AT, Moore AG, Miteff F, Hullick CJ, Attia J, McElduff P, Levi CR: Improving access to acute stroke therapies: a controlled trial of organised pre-hospital and emergency care. Med J Aust 2008, 189:429-433.
• [13]Maestroni A, Mandelli C, Manganaro D, Zecca B, Rossi P, Monzani V, Torgano G: Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy. J Emerg Med 2008, 25:340-345.
• [14]Mosley I, Nicol M, Donnan G, Patrick I, Kerr F, Dewey H: The Impact of Ambulance Practice on Acute Stroke Care. Stroke 2007, 38:2765-2770.
• [15]Lees KR, Bluhmki E, Kummer von R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010, 375:1695-1703.