Impact of “Stroke Code”-Rapid response team: An attempt to improve intravenous thrombolysis rate and to shorten Door-to-Needle time in acute ischemic stroke

Gurav, Sushma; Zirpe, Kapil; Rs, Wadia; Naniwadekar, Avinash; Pote, Prajakta; Tungenwar, Amit; Deshmukh, Abhijeet M; Mohopatra, Srikanta; Nimavat, Balakrishna; Surywanshi, Prasad

doi:10.4103/ijccm.ijccm_504_17

Cited by 20 publications

(14 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In general, direct admission is known to be associated with shorter onset-to-needle time and better outcome in patients with acute ischemic stroke undergoing thrombolysis [45–50]. This is because a direct admission to the telestroke could reduce the door-to-needle time for thrombolysis to within an hour in more than 70% of acute ischemic stroke patients and less than 50 min in more than 45% of stroke patients [51–53]. Many methods have been proposed to reduce door-to-needle time for thrombolysis, including in-hospital system-level centralized telestroke care [10, 13, 16, 54–58].…”

Section: Discussionmentioning

confidence: 99%

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

et al. 2018

View full text Add to dashboard Cite

BackgroundIn acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients.MethodsStructured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model.ResultsThe non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025–1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16–3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961–0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032–0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223–0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046–0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322–12.611, P = 0.014).ConclusionThe direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“… 18 Rapid response systems specialized in stroke help to reduce in‐hospital treatment delay, although the effect of discharge home is unknown. 18 …”

Section: Discussionmentioning

confidence: 99%

“…The influence of stroke on daily functioning and quality of life can affect discharge home. Time is a critical factor in the treatment of acute strokes, both hemorrhagic and ischemic 18 . Rapid response systems specialized in stroke help to reduce in‐hospital treatment delay, although the effect of discharge home is unknown 18 …”

Section: Discussionmentioning

confidence: 99%

“…Time is a critical factor in the treatment of acute strokes, both hemorrhagic and ischemic. 18 Rapid response systems specialized in stroke help to reduce in-hospital treatment delay, although the effect of discharge home is unknown. 18 Our results also revealed that patients with RRS call for anaphylaxis had a higher chance of home return regardless of the pathology.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study

Hongo

Naito

Fujiwara

et al. 2021

Acute Medicine & Surgery

View full text Add to dashboard Cite

Aim The rapid response system (RRS) is an in‐hospital medical safety system. To date, not much is known about patient disposition after RRS activation, especially discharge home. This study aimed to investigate the prevalence, characteristics, and outcomes of patients with adverse events who required RRS activation. Methods Retrospective data from the In‐Hospital Emergency Registry in Japan collected from April 2016 to November 2020 were eligible for our analysis. We divided patients into Home Discharge, Transfer, and Death groups. The primary outcome was the prevalence of direct discharge home, and independently associated factors were determined using multivariable logistic regression. Results We enrolled 2,043 patients who met the inclusion criteria. The prevalence of discharge home was 45.7%; 934 patients were included in the Home Discharge group. Age (adjusted odds ratio [AOR] 0.96; 95% confidence interval [CI], 0.95–0.97), malignancy (AOR 0.69; 95% CI, 0.48–0.99), oxygen administration before RRS (AOR 0.49; 95% CI, 0.36–0.66), cerebral performance category score on admission (AOR 0.38; 95% CI, 0.26–0.56), do not attempt resuscitation order before RRS (AOR 0.17; 95% CI, 0.10–0.29), RRS call for respiratory failure (AOR 0.50; 95% CI, 0.34–0.72), RRS call for stroke (AOR 0.12; 95% CI, 0.03–0.37), and intubation (AOR 0.20; 95% CI, 0.12–0.34) were independently negative, and RRS call for anaphylaxis (AOR 15.3; 95% CI, 2.72–86.3) was positively associated with discharge home. Conclusion Less than half of the in‐hospital patients under RRS activation could discharge home. Patients’ conditions before RRS activation, disorders requiring RRS activation, and intubation were factors that affected direct discharge home.

show abstract

“…8 Esta medida favorece a chegada rápida no serviço hospitalar e intervenções médicas precoces que poderão refletir na diminuição de sequelas e taxa de mortalidade pelo evento. 9 No Brasil, existem estudos populacionais que avaliam o conhecimento da população sobre o número do SAMU. 4,10,13 Pergola et al, aplicação questionários a 385 pedestres transeuntes na cidade de São Paulo, São Paulo, e constataram que apenas 37,6% sabiam o número do SAMU.…”

Section: Introductionunclassified

Avaliação do conhecimento de pacientes hospitalizados com Acidente Vascular Encefálico sobre o acionamento do Serviço de Atendimento Móvel de Urgência

Guimarães

Rodrigues²,

Santana³

et al. 2021

RECIS

View full text Add to dashboard Cite

Acidente vascular encefálico (AVE) é uma das principais causas de morte no Brasil e possui prognóstico variável a depender do tempo entre o início do quadro clínico e a intervenção médica. Este trabalho objetivou observar os conhecimentos dos pacientes com AVE sobre o número do Serviço de Atendimento Móvel de Urgência (SAMU). Foi feito um estudo transversal realizado por meio de entrevistas e questionários estruturados que avaliaram sexo, faixa etária, escolaridade, renda familiar e conhecimento sobre acionamento do SAMU. A amostra foi composta por 115 pacientes internados e diagnosticados com AVE em um hospital na cidade de Petrolina, Pernambuco. A maioria era do sexo masculino com idade superior a 50 anos. Havia predominância de pacientes sem alfabetização e grande parte apresentava renda familiar de até um salário mínimo. Apenas 41 dos 115 pacientes responderam corretamente o número do SAMU. Esse percentual é aquém do ideal, principalmente ao considerar que essa é uma população predisposta a apresentar recidivas do quadro e necessitar novamente do suporte do SAMU. O correto acionamento do SAMU, por meio do número de telefone 192, é uma etapa fundamental para o atendimento eficaz.

show abstract

Impact of “Stroke Code”-Rapid response team: An attempt to improve intravenous thrombolysis rate and to shorten Door-to-Needle time in acute ischemic stroke

Cited by 20 publications

References 22 publications

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study

Avaliação do conhecimento de pacientes hospitalizados com Acidente Vascular Encefálico sobre o acionamento do Serviço de Atendimento Móvel de Urgência

Contact Info

Product

Resources

About