Reducing time delays in the management of ischemic stroke patients in Northern Italy

Vidale, Simone; Arnaboldi, Marco; Bezzi, G; Bono, Giorgio; Grampa, G; Guidotti, Mario; Perrone, Patrizia; Salmaggi, Andrea; Zarcone, Davide; Zoli, Alberto; Agostoni, Elio

doi:10.1016/j.ijcard.2016.03.232

Cited by 12 publications

(11 citation statements)

References 26 publications

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“…Features of the included papers are listed in Table 1 . [ 6 – 90 ] The moderate risk of bias and the standard errors for included studies are depicted in the Supplemental Figures 2 to 8.…”

Section: Resultsmentioning

confidence: 99%

Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke

Huang

Zhang

et al. 2018

Medicine

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Section: Resultsmentioning

confidence: 99%

Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke

Huang

Zhang

et al. 2018

Medicine

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“…Under-recognition or delays in recognition of stroke symptoms are consistently identified as one of the main causes of pre-hospital delays [ 8 , 16 ]. Hence, with no surprise, population campaigns focused on stroke recognition, severity and existence of treatment emerged as a common factor to promote ART [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 20 , 23 , 34 , 36 , 38 , 39 , 40 , 41 , 46 , 48 , 103 , 104 , 105 , 106 , 107 , 108 ]. Sustainable levels of population awareness may only be achieved by continuous education campaigns, probably at least six months each [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Use of ambulance significantly reduced pre and intra-hospital delays, especially if pre-notification is made to the hospital allowing the hospital teams to check the patient’s previous clinical notes and the put everything involved in the chain of care in “preparedness mode” including the availability of the imaging room [ 12 , 15 , 16 , 17 , 20 , 22 , 23 , 37 , 39 , 40 , 44 , 48 , 51 , 61 , 92 , 96 , 97 , 98 , 110 , 111 , 112 , 113 ]. For time-dependent treatment, such as the ART, implementation of prehospital [ 51 , 61 , 75 , 98 , 107 ] and intrahospital [ 48 , 51 , 59 , 67 , 68 , 70 , 71 , 72 , 74 , 76 , 77 , 79 , 84 , 86 , 89 , 90 , 91 , 92 , 108 , 109 , 111 , 114 , 115 , 116 , 117 ] protocols are fundamental. Although methodology and pro...…”

Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

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“…Twenty-two studies quantified the time to admission for patients with IS, either as a percentage of patients arriving within a 3-hour or 6-hour time frame, and/or as a mean and median [1,4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Delay Of Patient's Consultation With Ischemic Stroke In Nort...mentioning

confidence: 99%

“…In Italy, (n=4) studies showed that the median prehospital delay was between 1 h 53 min and 5.4 h [9,11,24,25], of which two studies also reported an average admission time of 7.65 hours [11,24]. Besides, two other studies reported the proportion of patients admitted within 3 hours.…”

Section: Delay Of Patient's Consultation With Ischemic Stroke In Nort...mentioning

confidence: 99%

Pre-Hospital Delay and Associated Factors of Ischemic Stroke in Northern Mediterranean Countries: A Literature Review

Kharbach

Obtel

Baba

et al. 2019

EUR J BASIC MED SCI

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The emergence of new therapeutic protocols for reperfusion requires the respect of a therapeutic window which consists of an optimal admission time of 4.5 hours, and which should not exceed 6 hours according to the latest clinical trials. The objective of this narrative review of the literature is to identify the time of admission of patients arriving at emergency departments for ischemic stroke after the onset of symptoms, as well as the factors that influence it in four European countries of the Northern Mediterranean (Spain, France, Italy, and Turkey).Twenty-two studies published between 2004 and 2018 were included. The mean pre-hospital delay ranged from 7.65 hours to 22.5 hours. The median prehospital delay ranged from 1.54 to 6.08 hours. The proportion of patients consulting after the first 3 hours ranged from 31.6 to 96.29%. Almost half of the studies (45%) associated the transport used with early admission delay. More than a third of the studies (36%) revealed an association of this delay with the destination of the first call after the signs related to the stroke was noticed. Whereas, 32% of the studies showed that vigilance (consciousness) disorders were the symptoms most related to early admission due to their severity. In addition, advanced age was implicated in 27% of the studies as a determinant contributing to a reduction of the time to arrival of patients. Besides, the lack of awareness and underestimation of symptoms was reported in 13% of the studies, constituting the main barrier affecting negatively early admission.These findings show that the optimal therapeutic window recommended is not always respected even if in developed countries, and that ignorance about the symptoms evocative of ischemic stroke still remains in Northern Mediterranean countries. This implies that measures ought to be implemented in order to improve care in the best possible way, focusing mainly on educating and raising the awareness of the population about the signs of this disabling disease and the actions to be taken.

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Reducing time delays in the management of ischemic stroke patients in Northern Italy

Cited by 12 publications

References 26 publications

Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke

Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Pre-Hospital Delay and Associated Factors of Ischemic Stroke in Northern Mediterranean Countries: A Literature Review

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