Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review

Hassankhani, Hadi; Vahdati, Samad Shams; Mozaffari, Farough Amin; Fraser, Justin F.; Gilani, Neda

doi:10.1016/j.annemergmed.2018.08.435

Cited by 13 publications

(19 citation statements)

References 44 publications

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“…Iran, the meantime between hospital arrival and rTPA injection was 69 minutes (19). In Mowla's et al in New York, the highest imaging delay was over 25 minutes (21).…”

Section: Discussionmentioning

confidence: 96%

“…In a study in Iran, 80.2% of patients did not receive rTPA due to a delay of over 4 hour and 30 minutes. The most important reason for the delay in these patients was the delay in referring to the hospital (19). In another study in Iran, the mean arrival time of the patients to the hospital and CT scan was 91 minutes, which is 66 minutes longer than the international guidelines, and the mean arrival time and receiving rTPA was 147 minutes, which is 87 minutes longer compared international guidelines (20).…”

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confidence: 97%

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Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

Ghadimi¹,

Hanifi²,

Dinmohammadi³

2020

Preprint

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Background: Time-to-treatment affects the outcomes of acute ischemic stroke (AIS). The aim of this study was to determine the factors affecting pre-hospital and in-hospital delays in the time-to-treatment and complication in AIS. Methods: This prospective study was performed on 204 AIS patients referred to the stroke care unit in Iran (Zanjan) in 2019. Data were completed by interviewing the patients, their families, records, and observations. The mortality and complication rates were recorded for 30 post-stroke days through call follow-up. Results: The results showed that the highest delay was related to the onset-to-arrival time (288.19 ±339.02 minutes). Results of logistic regression showed that treatment delay declined significantly by consulting followed by symptoms onset, patient transfer through emergency medical service to the hospital, and patients’ understanding of AIS symptoms. The results also showed that increasing the onset-to-treatment time (P< .001) and high National Institutes of Health Stroke Scale (NIHSS) score (P< .000) were the most important factors associated with post-stroke complications. High age (P< .044) and high NIHSS scores (P< .001) were significantly associated with mortality in patients with AIS. Conclusion: Informing people about AIS symptoms and referring to AIS treatment units are essential in reducing the treatment time.

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“…Iran, the meantime between hospital arrival and rTPA injection was 69 minutes (19). In Mowla's et al in New York, the highest imaging delay was over 25 minutes (21).…”

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 97%

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

Ghadimi¹,

Hanifi²,

Dinmohammadi³

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In the study of Dhaliwal et al in the US, the mean initial CT scan time was 13.66 minutes, the CT scan interpretation time was 25.20 minutes, and the time between rTPA injection and the arrival of the patients was 51.27 minutes (36). Hasankhani et al in Tabriz (Iran) found that the mean time between hospital arrival and rTPA injection is 69 minutes (19). In the study of Mowla et al in New York, the maximum imaging delay was longer than 25 minutes (21).…”

Section: Discussionmentioning

confidence: 99%

“…In a study in Iran, rTPA was not provided for 80.2% of patients due to a delay of longer than 4 hours and 30 minutes. The delay in hospital referral was the main cause of the delay for such patients (19).…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

Ghadimi

Hanifi

Dinmohammadi

2021

Preprint

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Background: The results of acute ischemic stroke (AIS) are highly affected by time-to-treatment. This study aimed at determining the factors influencing the in-hospital and pre-hospital delays in the complications and time-to-treatment in AIS. Methods: The present prospective study was carried out on 204 AIS patients referring to the stroke care unit in Zanjan, Iran (2019). To collected the required data, the patients and families were interviewed, as well as using the observations and records. The complication and mortality rates were recorded for 30 days after stroke via call follow-ups. Results: Based on the obtained results, the maximum delay was associated with the onset-to-arrival time (288.19 ±339.02 minutes). The logistic regression results indicated a statistically significant decline in the treatment via consultation after initiating the symptoms, transferring the patient to the hospital via emergency medical service, and the patients’ comprehension regarding the AIS symptoms. It was also found that an increase in the onset-to-treatment time (P <.001) and higher National Institutes of Health Stroke Scale (NIHSS) scores (P< .001) are the most critical factors related to the post-stroke complications. The higher age (P <.044) and NIHSS scores (P < .001) were considerably related to the mortality in AIS patients. Conclusion: It is essential to inform people regarding AIS indicators and referring to AIS treatment units to reduce the treatment time.

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“…Implementation of these strategies in some low-resource setting regions in developing countries might not be applicable. What's more, advanced hospitals in developing countries are facing more implicit and intractable barriers from social and technical aspects [12]. Some hospitals have begun to introduce new technologies -such as intelligent authentication system or educational robot -to solve these situational problems.…”

Section: Introductionmentioning

confidence: 99%

Improving Thrombolysis for Acute Ischemic Stroke: The Implementation and Evaluation of a Theory-Based Resource Integration Project in China

Wang

Donglan

et al. 2022

Int J Integr Care

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Introduction: Intravenous thrombolysis for acute ischemic stroke remains underused in the developing countries. In 2016, a theory-based resource integration project was initiated at a major stroke center in China. This report describes the implementation process and results of the quality improvement project.Description: Eighteen environment-tailored interventions were implemented, including stroke code activation, electronic wristband bundling, structured information sharing, etc. The project was implemented from July 2016 to June 2017. A total of 519 acute ischemic stroke patients were included. After the intervention, median DNT decreased from 62 min to 37 min (P < 0.001). The percentage of cases treated within 30, 45 or 60 minutes increased from 2.5%, 17.4% and 44.6% to 27.4%, 69.4% and 84.7% respectively (P < 0.001). The median length of inpatient stay decreased from 10 days to 8 days (P < 0.001). The proportion of patients with severe disability decreased from 25.5% to 15.8% post-intervention.Discussion: Adequate pre-intervention activities are important conditions for the smooth implementation of the complex service integration initiative. The new treatment pathway has undergone a process of destruction, remodeling and solidification before stable and effective operation. In order to realize the full effect of service integration, whole society efforts are also required. Conclusions:Introduction of the theory-based resource integration project was associated with increased thrombolysis administrations, shorter DNT, and no statistically significant change in adverse outcomes. The basic principles of this project might be applicable to various resource settings.

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Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review

Cited by 13 publications

References 44 publications

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

Improving Thrombolysis for Acute Ischemic Stroke: The Implementation and Evaluation of a Theory-Based Resource Integration Project in China

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