Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India

Srivastava, M V Padma; Bhatia, Rohit; Vishnu, Venugopalan Y; Goyal, Mayank

doi:10.1161/strokeaha.119.026733

Cited by 16 publications

(18 citation statements)

References 37 publications

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“…The population-based registry studies in this review identified very small numbers of people who had a stroke and did not attend hospital [24][25][26] . However, reports from India suggest that many people who experience a stroke do not access hospital services for multiple reasons including: limited awareness of stroke symptoms or stroke being an emergency, large distances to travel between home and hospital, a lack of ambulance staff and transportation, the availability of alternative [non-hospital] therapies that people may consider effective after stroke, and limited finances to cover the cost of care 28,[38][39] . There were also limited data on the rates of hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Stroke in India: A systematic review of the incidence, prevalence, and case fatality

Jones

Baqai

Clegg

et al. 2021

International Journal of Stroke

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Background: The burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of stroke in India ranges between 105 and 152/100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. Aim: To identify high-quality prospective studies reporting the epidemiology of stroke in India. Summary of review: A search strategy was modified from the Cochrane Stroke Strategy and adapted for a range of bibliographic databases from January 1997 to August 2020. From 7,717 identified records, nine studies were selected for inclusion; three population-based registries, a further three population-based registries also using community-based ascertainment and three community-based door-to-door surveys. Studies represented the four cities of Mumbai, Trivandrum, Ludhiana, Kolkata, the state of Punjab and 12 villages of Baruipur in the state of West Bengal. The total population denominator was 22,479,509 and 11,654 (mean 1,294 SD 1,710) people were identified with incident stroke. Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year and one-month case fatality rates from 18% to 42%. Conclusions: Further high-quality evidence is needed across India to guide stroke policy and inform the development and organisation of stroke services. Future researchers should consider the World Health Organisation STEPwise approach to Surveillance (STEPS) framework, including longitudinal data collection, the inclusion of census population data and a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.

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Section: Discussionmentioning

confidence: 99%

Stroke in India: A systematic review of the incidence, prevalence, and case fatality

Jones

Baqai

Clegg

et al. 2021

International Journal of Stroke

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“…It may be inferred that centers catering to rural populations may have a significantly higher delay due to poor infrastructure as has been noted in other Indian population base studies. 20 , 21 This delay may further contribute to a prolonged DTN time at the tertiary center. This is evident in Figure 3 fish bone diagram, which also highlights the intra-hospital factors that led to a failure to achieve the ideal DTN time.…”

Section: Discussionmentioning

confidence: 99%

Stroke Thrombolysis: Beating the Clock

Diwan¹,

Shah²

2023

Indian Journal of Critical Care Medicine

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A bstract Background Recombinant tissue plasminogen activator (rtPA) has revolutionized the management of acute ischemic stroke. Shorter door-to-imaging and door-to-needle (DTN) times are crucial for improving the outcomes in thrombolysed patients. Our observational study evaluated the door-to-imaging time (DIT) and DTN times for all thrombolysed patients. Materials and methods The study was a cross-sectional observational study over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 52 underwent thrombolysis with rtPA. The time intervals between arrival to neuroimaging and initiation of thrombolysis were noted. Result Of the total patients thrombolysed, only 10 patients underwent neuroimaging [non-contrast computed tomography (NCCT) head with MRI brain screen] within 30 minutes of their arrival in the hospital, 38 patients within 30–60 minutes and 2 each within the 61–90 and 91–120 minute time frames. The DTN time was 30–60 minutes for 3 patients, while 31 patients were thrombolysed within 61–90 minutes, 7 patients within 91–120 minutes, while 5 each took 121–150 and 151–180 minutes for the same. One patient had a DTN between 181 and 210 minutes. Conclusion Most patients included in the study underwent neuroimaging within 60 minutes and subsequent thrombolysis within 60–90 minutes of their arrival in the hospital. But the time frames did not meet the recommended ideal intervals, and further streamlining of stroke management is needed even at tertiary care centers in India. How to cite this article Shah A, Diwan A. Stroke Thrombolysis: Beating the Clock. Indian J Crit Care Med 2023;27(2):107–110.

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“…56,58,59 Studies emphasise the need for stroke specialists and professionals (stroke teams, competence, skill, awareness, confidence and experience in dealing with clinical situations) to ensure quality stroke care. [60][61][62][63] According to Prasad et al, 56 the stroke team should be available 24 × 7 and a member of the team should be at patient bedside within 15 minutes of being called. In reality, with staff strength of both RSUTH, achieving Prasad et al's suggestion is far beyond realistic.…”

Section: Medical Teammentioning

confidence: 99%

Exploring the Essential Stroke Care Structures in Tertiary Healthcare Facilities in Rivers State, Nigeria

Osuegbu

Adeniji

Owhonda

et al. 2022

INQUIRY

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This study evaluated the essential stroke care structure available in the two Tertiary Health Facilities in Rives State, Nigeria. This was a descriptive survey involving the Stroke Care Survey and Assessment Tool (checklist/questionnaire) developed by the World Stroke Organisation to obtain information about the available essential stroke care structure (facilities, equipment, personnel and management protocol) at the two tertiary health facilities (RSUTH & UPTH). The study gathered relevant information, which was summarised into tables and graphs using Microsoft Excel 2016. From the results, although facilities had A and E departments, dedicated stroke units (fixed or mobile) were unavailable, and there was no locally developed protocol to support rapid triage of stroke patients. The facilities and equipment were either unavailable or insufficient. Only one health facility (RSUTH) provided 24 hrs/7 days laboratory services. The workforces were a mix between regular clinical staff and some specialists. Tissue plasminogen activator (tPA) use was non-existent, though specialists were trained on its administration. There was no locally developed or adopted stroke-specific clinical guidelines. In conclusion, the structural services available for stroke care within the studied tertiary health facilities were poor, unavailable or grossly insufficient. The state facility (RSUTH) suffered the most in terms of unavailable national support and staff development.

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Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India

Cited by 16 publications

References 37 publications

Stroke in India: A systematic review of the incidence, prevalence, and case fatality

Stroke in India: A systematic review of the incidence, prevalence, and case fatality

Stroke Thrombolysis: Beating the Clock

Exploring the Essential Stroke Care Structures in Tertiary Healthcare Facilities in Rivers State, Nigeria

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