Hospital arrival time and functional outcome after acute ischaemic stroke: Results from the PREMIER study

León-Jiménez, Carolina; Ruiz-Sandoval, José Luís; Chiquete, Erwin; Vega-Arroyo, M.; Araúz, Antonio; Murillo-Bonilla, Luis Manuel; Ochoa-Guzmán, Ana; Carrillo-Loza, Karina; Ramos-Moreno, Alma; Barinagarrementería, Fernando; Cantú-Brito, Carlos

doi:10.1016/j.nrleng.2013.05.005

Cited by 24 publications

(19 citation statements)

References 28 publications

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“…(Class IIa, level of evidence B) ► Apply 6-SIGMA management method to improve the quality of green channel, implementing 'Define (setting process improvement objectives); Measure (decomposing process to measure the time needed in current process); Analysis (using various statistical strategies to analyse the reasons for failure to achieve standards); Improve The purpose of establishing stroke centre is to improve stroke medical staff and facilities, so as to adapt them to the methods of stroke treatment and improve the level of stroke diagnosis and treatment. 7 The US health facility accreditation programme classifies stroke centres into three levels: CSC, PSC and stroke ready hospital. As early as 2000, BAC published a proposal to develop PSC, so as to improve the level of stroke diagnosis and treatment in the USA and improve stroke outcomes.…”

Section: Level Of Evidencementioning

confidence: 99%

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update on organizational stroke management

Lou

Ding

et al. 2020

Stroke Vasc Neurol

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AimStroke is characterised by high morbidity, mortality and disability, which seriously affects the health and safety of the people. Stroke has become a serious public health problem in China. Organisational stroke management can significantly reduce the mortality and disability rates of patients with stroke. We provide this evidence-based guideline to present current and comprehensive recommendations for organisational stroke management.MethodsA formal literature search of MEDLINE (1 January 1997 through 30 September 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association’s Levels of Evidence grading algorithm was used to grade each recommendation.ResultsEvidence-based guidelines are presented for the organisational management of patients presenting with stroke. The focus of the guideline was subdivided into prehospital first aid system of stroke, rapid diagnosis and treatment of emergency in stroke centre, organisational management of stroke unit and stroke clinic, construction of regional collaborative network among stroke centres and evaluation and continuous improvement of stroke medical quality.ConclusionsThe guidelines offer an organisational stroke management model for patients with stroke which might help dramatically.

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Section: Level Of Evidencementioning

confidence: 99%

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update on organizational stroke management

Lou

Ding

et al. 2020

Stroke Vasc Neurol

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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 .…”

Section: Discussionmentioning

confidence: 99%

“…We collected the data with a standardized structured case report format (CRF) specifically created for the purposes of the study to be used in a homogeneous and standard fashion by a total of two trained researchers, one per participating center. This CRF has been previously used in other multicenter research projects in Mexico 10 and included the patient's demographic characteristics, past medical history, and pre-hospital clinical manifestations (gathered from the subject who witnessed the event). The clinical features were grouped into the pre-established neurovascular categories.…”

Section: Methodsmentioning

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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“…Hospital admission time after ischemic stroke onset has been known to be an important factor influencing the clinical outcome and prognosis 19 . Previous studies reported that earlier hospital arrival correlated with poorer clinical outcome, as patients with more severe symptoms have a tendency to get to the hospital earlier [20][21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

Impact of Onset to Hospital Admission Time on Clinical Outcome in Patients with Ischemic Stroke without Reperfusion Therapy

Pinzon,

Wijono

2018

Cent. Asian j. Med. Sci.

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Objective:The narrow therapeutic window after stroke onset is a major concern in stroke treatment, especially in developing countries. This study aimed to investigate the correlation between onset to hospital admission time and clinical outcome in patients with ischemic stroke who did not receive reperfusion therapy. Method: A total of 313 patients with ischemic stroke were recruited in this retrospective cohort study. Data were obtained from the electronic stroke registry of Bethesda Hospital Yogyakarta, Indonesia. Ischemic stroke was diagnosed by welltrained neurologists and confirmed by brain CT-scan. Clinical outcome was assessed using the modified Rankin scale. Predictors of clinical outcome were assessed. Data analysis was conducted using multiple logistic regression. Results: The incidence of disability and death were 30.4% (95/313) and 7.6% (24/313) respectively. Multiple logistic regression analysis showed onset to hospital admission time greater than 6 hours (OR: 4.56; 95% CI:2.372-8.792; p<.001 was an independent factor to a significant increase in disability risk. However, longer onset to hospital admission time did not significantly increase the risk of death. Age and complications were independent predictive factors of both disability (OR: 2.36; 95% CI:1. p=.002 and OR: 12.4; p=.002, respectively) and mortality (OR: 3.66; 95% CI:1. p=.028 and OR: 58.8; p<.001, respectively). Conclusion: Shorter onset to hospital admission time could save ischemic stroke patients from disability. Cent Asian J Med Sci. 2018 Dec;4(4):300-305.

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Hospital arrival time and functional outcome after acute ischaemic stroke: Results from the PREMIER study

Cited by 24 publications

References 28 publications

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update on organizational stroke management

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update on organizational stroke management

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

Impact of Onset to Hospital Admission Time on Clinical Outcome in Patients with Ischemic Stroke without Reperfusion Therapy

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