Contribution of Onset-to-Alarm Time to Prehospital Delay in Patients with Ischemic Stroke

González-Aquines, Alejandro; Cordero-Pérez, Adolfo C; Cristobal-Niño, Mario; Pérez-Vázquez, Gil; Góngora‐Rivera, Fernando; Investigators, Gecen

doi:10.1016/j.jstrokecerebrovasdis.2019.104331

Cited by 25 publications

(22 citation statements)

References 27 publications

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“…Of the remaining 91,864 patients with AIS, 43% presented with an NIHSS score ≤3, 33% with an NIHSS score ranging 4-9 and 24% with an NIHSS score ≥10. In line with the previous findings, an inverse association between stroke severity and onset to door-time became evident (median, NIHSS ≥10: 246 min, 4-9: 389 min, ≤3: 503 min) (10). Patients excluded from this analysis had a longer onset-to-door time (median 630 min) than the subgroup of patients with mild stroke.…”

Section: Study Populationsupporting

confidence: 89%

Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning

et al. 2020

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Background: Widespread quick access to mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is one of the main challenges in stroke care. It is unclear if newly established MT units are required 24 h/7 d. We explored the diurnal admission rate of patients with AIS potentially eligible for MT to provide a basis for discussion of daytime-adapted stroke care concepts. Methods: Data collected from the Baden-Württemberg Stroke Registry in Germany were assessed (2008-2012). We analyzed the admission rate of patients with AIS stratified by the National Institutes of Health Stroke Scale (NIHSS) score at admission in 3-h intervals. An NIHSS score ≥10 was considered a predictor of large vessel occlusion. The average annual admission number of patients with severe AIS were stratified by stroke service level and calculated for a three-shift model and working/non-working hours. Results: Of 91,864, 22,527 (21%) presented with an NIHSS score ≥10. The average admission rates per year for a hospital without Stroke Unit (SU), with a local SU, with a regional SU and a stroke center were 8, 52, 90 and 178, respectively. Approximately 61% were admitted during working hours, 54% in the early shift, 36% in the late shift and 10% in the night shift. Conclusions: A two-shift model, excluding the night shift, would cover 90% of the patients with severe AIS. A model with coverage during working hours would miss ∼40% of the patients with severe AIS. To achieve a quick and area-wide MT, it seems preferable for newly implemented MT-units to offer MT in a two-shift model at a minimum.

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Section: Study Populationsupporting

confidence: 89%

Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning

et al. 2020

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“…The quality of pre-hospital care is reflected by the onset-todoor time (ODT) that is the time from stroke onset, or from the last moment the patient was known without symptoms, to emergency department (ED) arrival [5]. The indicators of the in-hospital care pathway are the time elapsing from the moment the patient enters the ED to the moment he/she receives revascularization procedures such as IVT, the door-to-needle time (DNT), and/or EVT, the door-to-groin time (DGT) [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

et al. 2020

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Objective To evaluate the impact of the lockdown measures, consequent to the outbreak of COVID-19 pandemic, on the quality of pre-hospital and in-hospital care of patients with acute ischemic stroke. Methods This is an observational cohort study. Data sources were the clinical reports of patients admitted during the first month of lockdown and discharged with a confirmed diagnosis of stroke or TIA. Data were collected in the interval ranging from March 11th to April 11th 2020. As controls, we evaluated the clinical reports of patients with stroke or TIA admitted in the same period of 2019. Results The clinical reports of patients eligible for the study were 52 in 2020 (71.6 ± 12.2 years) and 41 in 2019 (73.7 ± 13.1 years). During the lockdown, we observed a significant increase in onset-to-door time (median = 387 vs 161 min, p = 0.001), a significant reduction of the total number of thrombolysis (7 vs 13, p = 0.033), a non-significant increase of thrombectomy (15 vs 9, p = 0.451), and a significant increase in door-to-groin time (median = 120 vs 93 min, p = 0.048). No relevant difference was observed between 2019 and 2020 in the total number of patients admitted. Conclusions Due to the COVID-19 pandemic and lockdown measures, the stroke care pathway changed, involving both prehospital and in-hospital performances.

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“…The recognition of an acute stroke may vary among different populations [10][11][12][13][14] . The communication between the EMS personnel and the bystander witnessing an acute cerebrovascular emergency with preestablished methods has improved clinical outcomes in other countries 3,12,15 . The in-hospital outcome of stroke patients might improve by identifying a neurovascular emergency correctly, regardless of its final etiology 4,5,12,16,17 .…”

Section: Discussionmentioning

confidence: 99%

“…Initial and timely recognition of an acute stroke by the event's witness is a factor that directly affects the outcome and functional prognosis in all neurovascular emergencies [1][2][3][4] . The pre-hospital classification of other vascular emergencies, such as acute coronary syndrome, has proven to shorten the response time by the emergency medical system (EMS), improving the short-term prognosis 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings

Chiquete¹,

Sandoval-Rodríguez²,

García‐Grimshaw³

et al. 2021

RIC

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Background: The recognition of stroke symptoms by patients or bystanders directly affects the outcomes of patients with acute cerebrovascular disease. Objective: The objective of the study was to assess the predictive value of the medical history and clinical features recognized by the patients' bystanders to classify neurovascular syndromes in pre-hospital settings. Methods: We included 150 stroke patients of two Mexican referral centers: 50 with acute ischemic stroke (AIS), 50 with intracerebral hemorrhage (ICH), and 50 with subarachnoid hemorrhage (SAH). The performance of clinical prediction rules (CPR) to identify the stroke types was evaluated with features recognized by the patients' bystanders before hospital arrival. The impact of CPRs on early arrival and in-hospital mortality was also analyzed. Results: Overall, 72% of the patients had previous medical evaluations in other centers before final referral to our hospitals, and therefore, only 45% had a final onsetto-door time <6 h, even when the first medical assessment had occurred in ≤1 h in 75% of cases. Clinical features noticed by the patients' bystanders had low positive predictive values (PPV) for any stroke type. The CPR "language or speech disorder + focal motor deficit" had 93% sensitivity and a negative predictive value (NPV) of 84% to distinguish AIS. In SAH, headache alone showed a sensitivity of 84% and NPV of 97%. No CPR had an adequate performance on ICH. CPRs were not associated with final onset-to-door time. Altered consciousness, age ≥65 years, indirect arrival with stops before final referral, and atrial fibrillation increased in-hospital mortality. Conclusion: Clinical features referred by the witness of a neurovascular emergency have limited PPV, but adequate NPV in ruling-out AIS and SAH among stroke types. The use of CPRs had no impact on onset-to-door time or in-hospital mortality when the final arrival to a third-level center occurs with previous medical referrals. (REV INVEST CLIN. [AHEAD OF PRINT]

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Contribution of Onset-to-Alarm Time to Prehospital Delay in Patients with Ischemic Stroke

Cited by 25 publications

References 27 publications

Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning

Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning

Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings

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