Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians

Heikkilä, Iiro; Kuusisto, Hanna; Holmberg, Markus; Palomäki, Ari

doi:10.1016/j.annemergmed.2018.07.019

Cited by 18 publications

(17 citation statements)

References 30 publications

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“…Diagnostic practice for these patients with AIS and need for EVT were very straightforward without unnecessary delays. This was possible because of our lean AIS process, where paramedics, emergency physicians, nurses, laboratory technicians and the staff of the radiology unit have organized seamless co-operation [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…He was able to call his wife, who at 19:30 contacted the dispatch centre by dialling 112. After EMS arrived on the scene, the paramedics consulted an emergency physician and the stroke protocol [8] was initiated.…”

Section: Case Presentationsmentioning

confidence: 99%

“…When a decision on potential endovascular treatment has been made, the patient will be transferred by the same EMS unit. The role of emergency physicians in this is decisive, and during the first year of implementation we achieved a median door-to-needle time (DNT) of 20 minutes with good clinical outcomes [8]. Our ED serves as a primary stroke centre (PSC) in a secondary care hospital with no on-site mechanical thrombectomy service.…”

Section: Introductionmentioning

confidence: 99%

“…Although our AIS protocol [7,8] has remained unchanged during the COVID-19 epidemic, the circumstances may change. All patients are triaged and screened for COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre

2021

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COVID-19 epidemic has had a negative effect on the resources of emergency departments. While the number of acute ischaemic stroke (AIS) patients eligible for reperfusion therapies has decreased in the emergency departments (EDs), times to thrombolytic and endovascular treatments of AIS patients have become longer. In this paper, we report an ultra-fast diagnostic protocol in the settings of AIS in the ED of a primary stroke centre. Experiences using case studies of three patients have also been provided. Patients treated in accordance with the protocol received primary diagnoses and endovascular treatment with door-in-door-out times of 15 to 21 minutes.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Although our AIS protocol [7,8] has remained unchanged during the COVID-19 epidemic, the circumstances may change. All patients are triaged and screened for COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre

2021

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“…In addition, emergency medicine has been introduced as a separate specialty branch in Finland in 2013 [6]. Since then, there has been a continuous reappraisal and development of its functionality within the inter-disciplinary management of patients, such as those operated for an acute abdominal condition [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Immediate effects of urgent reorganisation of emergency department-based treatment pathway in nonperforated appendicitis: a retrospective study

et al. 2020

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Background: Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. Postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess, whether this reorganisation was feasible and safe, i.e. did it affect the length of in-hospital stay (LOS) and the 30-day complication rate. Methods: This is a retrospective pre-and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-h observation unit of the ED instead of surgical ward. Patients operated during the first 3 months after the reorganisation were compared to those operated during the 3 months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age < 18 years and perforated disease. Results: Appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7 h for all patients after the reorganisation compared to 24.4 h before the reorganisation (standard error 6.2 h, 95% confidence interval 2.3-15.2 h, p < 0.01). There were no more complications in the group treated postoperatively in the ED. Conclusions: Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the EDinstead of the surgical wardoccurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.

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Stroke Experiences and Unmet Needs of Individuals of African Descent Living in High-Income Economy Countries: a Qualitative Meta-Synthesis

Singh

Fakembe

Brown

et al. 2023

J. Racial and Ethnic Health Disparities

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Background Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants’ unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care. Methods A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses. Results Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences. Conclusions This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.

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Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians

Abstract: Implementation of a stroke protocol with emergency physician-directed acute care decreased both door-to-needle time and onset-to-treatment time without increasing the rate of symptomatic intracerebral hemorrhage.

Cited by 18 publications

References 30 publications

Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre

Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre

Immediate effects of urgent reorganisation of emergency department-based treatment pathway in nonperforated appendicitis: a retrospective study

Stroke Experiences and Unmet Needs of Individuals of African Descent Living in High-Income Economy Countries: a Qualitative Meta-Synthesis

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