A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment

Mohedano, A.M. Iglesias; Pastor, A. García; Otero, Francisco Javier Sanjiao; Alén, P. Vázquez; Gómez, M.A. Martín; Campo, Paula; Cámara, Paula Salgado; Antonio, Ester Esteban de; García, E. Gargallo; Molina, C. Marín; Diéguez, M. del Valle; Lorente, Javier; Bullido, Y. Fernández; Núñez, A. Gil

doi:10.1016/j.nrleng.2018.03.009

Cited by 6 publications

(21 citation statements)

References 20 publications

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“…Out of 35 articles included in this review, 34 (97.1%) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 were published in English and one (2.9%) 46 in both English and Spanish. Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania. 16 41 42 From the included articles, 15 (42.9%) were performed in the United States of America, 13 1...…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania. 16 41 42 From the included articles, 15 (42.9%) were performed in the United States of America, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 4 (11.4%) in China, 12 25 36 43 3 (8.6%) in Australia, 16 41 42 2 (5.7%) in Japan, 19 33 2 (5.7%) in the Netherlands, 23 34 2 (5.7%) in Norway, 14 35 and 7 (20.0%) in varying countries 15 20 27 28 29 32 46 (…”

Section: Resultsmentioning

confidence: 99%

“…Only 1 study 38 reported improvement in the symptoms' onset-to-door time after protocol implementation, out of 14 studies 14 16 23 27 30 36 37 38 39 40 41 42 43 46 that approached this outcome. All (19) studies 13 16 23 24 25 27 28 30 31 32 36 38 39 40 41 42 43 44 46 that addressed door-to-image time reported improving it. Image-to-needle time improved in 10 studies 15 16 19 23 25 26 30 36 41 46 out of 11 15 16 19 23 25 26 30 32 36 41 46 that assessed it.…”

Section: Resultsmentioning

confidence: 99%

“…Image-to-needle time improved in 10 studies 15 16 19 23 25 26 30 36 41 46 out of 11 15 16 19 23 25 26 30 32 36 41 46 that assessed it. Door-to-needle time improved in 29 studies 12 13 15 16 17 18 20 22 23 24 25 26 27 28 29 30 32 34 35 36 37 38 39 40 41 42 43 45 46 out of 32 studies 12 13 15 16 17 18 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 …”

Section: Resultsmentioning

confidence: 99%

“…This time is closely related to the structural and operational reorganization to provide adequate and timely care to affected cases in the stroke care units, and can also be reduced if an adequate diagnostic hypothesis is raised for stroke cases by the prehospital urgency and emergency medical services, 40 45 50 54 with the intention of quickly activating the stroke code. 46 50 55…”

Section: Discussionmentioning

confidence: 99%

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Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

et al. 2022

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Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

et al. 2022

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Bolus-to-Infusion Time in Stroke Patients Treated with Alteplase on the CT Table: A Clinical Concern

et al. 2019

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Impact of implementing a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia

Alzahrani,

Sulaiman,

Babakkor

et al. 2023

NSJ

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Objectives: To assess the impact of a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia. Stroke is one of the most common medical problems globally. Tissue plasminogen activator is an effective treatment in patients with acute ischemic stroke. However, its efficacy is time-dependent. Methods: We conducted a retrospective study on acute ischemic stroke patients who presented within the study window and were eligible for intravenous thrombolysis therapy at King Abdullah Medical City in Makkah between September 1, 2015 and July 2020. Results: Sixty-nine patients received intravenous tissue plasminogen activator and enrolled in this study, 28 patients of which presented during the Hajj period. We found a statistically significant reduction in both the door to needle time and the door to computed tomography time during the Hajj period. In addition, the length of hospital stay reduced significantly in the same period Conclusion: We observed a 44% reduction in the door to needle time during the implementation of the stroke code. However, we did not observe a significant difference in clinical outcomes. This study is limited by its small sample size and it lacks a long follow-up for clinical conditions.

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A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment

Cited by 6 publications

References 20 publications

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

Bolus-to-Infusion Time in Stroke Patients Treated with Alteplase on the CT Table: A Clinical Concern

Impact of implementing a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia

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