Comparing performance measures and clinical outcomes between mobile stroke units and usual care in underserved areas

Nilanont, Yongchai; Chanyagorn, Pornchai; Shukij, Karuna; Pengtong, Waitayaporn; Kongmuangpuk, Mananchaya; Wongmayurachat, Kanokkarn; Nittayaboon, Kittiya; Wongsawat, Yodchanan; Sirovetnukul, R.; Chakorn, Tipa; Riyapan, Sattha; Kaveeta, Chitapa; Chotik-anuchit, Songkram; Tongdee, Trongtum; Thabmontian, Ploypailin; Saeheng, Porntep; Nopmaneejumruslers, Cherdchai; Vamvanij, Visit

doi:10.1007/s10072-022-06550-6

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…It was probably due to a balancing effect linked to improvements in the acute management, in particular DTN reduction, and therefore in the effectiveness of treatment. The relationship between the reduction in time metrics and a higher chance of getting a good neurological recovery at 3 months is also reported by scientific literature [ 28 ].…”

Section: Discussionmentioning

confidence: 60%

Stroke pathway performance assessment: a retrospective observational study

Camporesi,

Strumia,

Di Pilla

et al. 2023

BMC Health Serv Res

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Background and Aim Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic. Methods A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3 m-mRS) and NIHSS score 24 h after the ischemic event onset (24 h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020). Results 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000). A statistically significant reduction over the years was found for DTN, going from 90 min to 61 min (p = 0.000) with also an increase in the number of thrombolysis performed within the “golden hour” – more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs. 0.72, p = 0.048). The pre-hospital process indicator OTD increased from 88.13 to 118.48 min, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3 m-mRS, NHISS and 24 h-NHISS. Conclusions The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients’ outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage.

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Section: Discussionmentioning

confidence: 60%

Stroke pathway performance assessment: a retrospective observational study

Camporesi,

Strumia,

Di Pilla

et al. 2023

BMC Health Serv Res

View full text Add to dashboard Cite

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Impact of Gender and Marital Status on Door-to-Treatment (DTT) Time and Acute Stroke Outcome

Karim,

Tumin,

Karim

2024

The Neurologist

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Objectives: Delays in acute stroke treatment lead to poor outcomes. Women can present with atypical stroke symptoms, are older at the time of stroke, and tend to be living alone, causing delays in pre-hospital diagnosis and seeking care. It is unclear if gender disparities in ED arrival and stroke assessment are compounded by gender differences after ED arrival. Therefore, we sought to identify if gender and marital status were associated with faster door-to-treatment (DTT) time. Methods: Our single-center stroke database was queried for adults presenting to ED with acute stroke between January 1, 2018 and January 30, 2023 treated with IV thrombolytics (IVT)+/− endovascular thrombectomy (EVT) and a known DTT time. The primary outcome was DTT (door-to-needle+door-to-puncture) time. Data collected includes the National Institutes of Health Stroke Scale (NIHSS) at presentation and discharge, gender, marital status, age, and intervention (IVT alone or IVT+/− EVT). Results: Among 674 patients identified, 35 patients were excluded due to missing data. Of 639 patients (median age 66 y), 25%/18% of patients were married men/women, respectively, and 22%/35% were single men/women. Median DTN time, DTP time, and discharge NIHSS score were 36, 79, and 4 mins, respectively. On multivariable analysis, neither DTT time nor NIHSS score at discharge improved among married men relative to any other combination of gender and marital status. Conclusions: Gender differences in the knowledge of stroke warning signs and gender disparities in ED assessment did not translate into faster DTT time. More work is needed to find ways to accelerate stroke care after ED arrival.

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Stroke Pathway performance and impact of the COVID-19 pandemic in a first level Stroke Unit in Northen Italy: an observational study

Camporesi,

Strumia,

Pilla

et al. 2023

Preprint

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Background and Aim Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic. Methods A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3m-mRS) and NIHSS score 24 hours after the ischemic event onset (24h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020). Results 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000). A statistically significant reduction over the years was found for DTN, going from 90 minutes to 61 minutes (p = 0.000) with also an increase in the number of thrombolysis performed within the “golden hour” – more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs 0.72, p = 0.048). The pre-hospital process indicator OTD increased from 88.13 to 118.48 minutes, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3m-mRS, NHISS and 24h-NHISS. Conclusions The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients’ outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage.

show abstract

Comparing performance measures and clinical outcomes between mobile stroke units and usual care in underserved areas

Cited by 5 publications

References 18 publications

Stroke pathway performance assessment: a retrospective observational study

Stroke pathway performance assessment: a retrospective observational study

Impact of Gender and Marital Status on Door-to-Treatment (DTT) Time and Acute Stroke Outcome

Stroke Pathway performance and impact of the COVID-19 pandemic in a first level Stroke Unit in Northen Italy: an observational study

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