Pre-hospital notification is associated with improved stroke thrombolysis timing

Ming Khor, Alex Bown, Alistair Barrett, Carl E Counsell, Mary Macleod, John M. Reid

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6 Citations (Scopus)
4 Downloads (Pure)

Abstract

Intravenous thrombolysis increases disability-free survival after acute ischaemic stroke in a time-dependent fashion. We aimed to determine whether pre-hospital notification, introduction of a CT scanner near to assessment site and introduction of out-of-hours thrombolysis services affect thrombolysis timing. Methods Timings related to thrombolysis were collected between May 2012 and June 2014 at a single hospital site; these included time to stroke physician assessment, time to cranial CT imaging and door to needle time. All thrombolysed ischaemic stroke patients admitted via the emergency department were included. Ambulance services were asked to pre-notify the emergency department of any suspected stroke patient during this period. Results We studied 182 patients (48% female; mean age 74 years; 59% pre-notified). Pre-hospital notification was associated with a significantly higher rate of CT scanning within 25 minutes (60% vs 24%, odds ratio [OR] 4.7, 95% confidence interval [CI] 2.4–9.0; p<0.001), earlier stroke physician assessment (median 6 vs 32 minutes; p<0.001) and receiving thrombolysis within 60 minutes (89% vs 49%, OR 8.0, 95% CI 3.8–16.9; p<0.001). Being treated outside normal working hours did not alter thrombolysis timing. Logistic regression identified the introduction of a near-site CT scanner (OR 4.6 [95% CI 1.7–12.5]) and pre-hospital notification (OR 4.7, [95% CI 2.3–9.6]) as independent predictors of door to CT time ≤25 minutes, and pre-hospital notification (OR 11.6, [95% CI 4.9-30.3]) and stroke severity (OR 1.15 per point of NIHSS scale, [95% CI 1.08-1.23]) as predictors of door to thrombolysis time ≤60 minutes. The most common perceived timing delays were radiology-related (33%), the need to acutely lower blood pressure (15%) and obtaining consent (12%). Conclusion Pre-hospital notification is associated with earlier stroke physician review, CT imaging and delivery of thrombolysis. Referral to an out of hours thrombolysis service was not associated with additional delay.
Original languageEnglish
Pages (from-to)190-195
Number of pages6
JournalJournal of the Royal College of Physicians of Edinburgh
Volume45
Issue number3
DOIs
Publication statusPublished - Oct 2015

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Keywords

  • acute stroke
  • ambulance services
  • computed tomography
  • pre-hospital notification
  • thrombolysis

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Pre-hospital notification is associated with improved stroke thrombolysis timing. / Khor, Ming; Bown, Alex; Barrett, Alistair; Counsell, Carl E; Macleod, Mary; Reid, John M.

In: Journal of the Royal College of Physicians of Edinburgh, Vol. 45, No. 3, 10.2015, p. 190-195.

Research output: Contribution to journalArticle

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title = "Pre-hospital notification is associated with improved stroke thrombolysis timing",
abstract = "Intravenous thrombolysis increases disability-free survival after acute ischaemic stroke in a time-dependent fashion. We aimed to determine whether pre-hospital notification, introduction of a CT scanner near to assessment site and introduction of out-of-hours thrombolysis services affect thrombolysis timing. Methods Timings related to thrombolysis were collected between May 2012 and June 2014 at a single hospital site; these included time to stroke physician assessment, time to cranial CT imaging and door to needle time. All thrombolysed ischaemic stroke patients admitted via the emergency department were included. Ambulance services were asked to pre-notify the emergency department of any suspected stroke patient during this period. Results We studied 182 patients (48{\%} female; mean age 74 years; 59{\%} pre-notified). Pre-hospital notification was associated with a significantly higher rate of CT scanning within 25 minutes (60{\%} vs 24{\%}, odds ratio [OR] 4.7, 95{\%} confidence interval [CI] 2.4–9.0; p<0.001), earlier stroke physician assessment (median 6 vs 32 minutes; p<0.001) and receiving thrombolysis within 60 minutes (89{\%} vs 49{\%}, OR 8.0, 95{\%} CI 3.8–16.9; p<0.001). Being treated outside normal working hours did not alter thrombolysis timing. Logistic regression identified the introduction of a near-site CT scanner (OR 4.6 [95{\%} CI 1.7–12.5]) and pre-hospital notification (OR 4.7, [95{\%} CI 2.3–9.6]) as independent predictors of door to CT time ≤25 minutes, and pre-hospital notification (OR 11.6, [95{\%} CI 4.9-30.3]) and stroke severity (OR 1.15 per point of NIHSS scale, [95{\%} CI 1.08-1.23]) as predictors of door to thrombolysis time ≤60 minutes. The most common perceived timing delays were radiology-related (33{\%}), the need to acutely lower blood pressure (15{\%}) and obtaining consent (12{\%}). Conclusion Pre-hospital notification is associated with earlier stroke physician review, CT imaging and delivery of thrombolysis. Referral to an out of hours thrombolysis service was not associated with additional delay.",
keywords = "acute stroke, ambulance services, computed tomography, pre-hospital notification, thrombolysis",
author = "Ming Khor and Alex Bown and Alistair Barrett and Counsell, {Carl E} and Mary Macleod and Reid, {John M.}",
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T1 - Pre-hospital notification is associated with improved stroke thrombolysis timing

AU - Khor, Ming

AU - Bown, Alex

AU - Barrett, Alistair

AU - Counsell, Carl E

AU - Macleod, Mary

AU - Reid, John M.

PY - 2015/10

Y1 - 2015/10

N2 - Intravenous thrombolysis increases disability-free survival after acute ischaemic stroke in a time-dependent fashion. We aimed to determine whether pre-hospital notification, introduction of a CT scanner near to assessment site and introduction of out-of-hours thrombolysis services affect thrombolysis timing. Methods Timings related to thrombolysis were collected between May 2012 and June 2014 at a single hospital site; these included time to stroke physician assessment, time to cranial CT imaging and door to needle time. All thrombolysed ischaemic stroke patients admitted via the emergency department were included. Ambulance services were asked to pre-notify the emergency department of any suspected stroke patient during this period. Results We studied 182 patients (48% female; mean age 74 years; 59% pre-notified). Pre-hospital notification was associated with a significantly higher rate of CT scanning within 25 minutes (60% vs 24%, odds ratio [OR] 4.7, 95% confidence interval [CI] 2.4–9.0; p<0.001), earlier stroke physician assessment (median 6 vs 32 minutes; p<0.001) and receiving thrombolysis within 60 minutes (89% vs 49%, OR 8.0, 95% CI 3.8–16.9; p<0.001). Being treated outside normal working hours did not alter thrombolysis timing. Logistic regression identified the introduction of a near-site CT scanner (OR 4.6 [95% CI 1.7–12.5]) and pre-hospital notification (OR 4.7, [95% CI 2.3–9.6]) as independent predictors of door to CT time ≤25 minutes, and pre-hospital notification (OR 11.6, [95% CI 4.9-30.3]) and stroke severity (OR 1.15 per point of NIHSS scale, [95% CI 1.08-1.23]) as predictors of door to thrombolysis time ≤60 minutes. The most common perceived timing delays were radiology-related (33%), the need to acutely lower blood pressure (15%) and obtaining consent (12%). Conclusion Pre-hospital notification is associated with earlier stroke physician review, CT imaging and delivery of thrombolysis. Referral to an out of hours thrombolysis service was not associated with additional delay.

AB - Intravenous thrombolysis increases disability-free survival after acute ischaemic stroke in a time-dependent fashion. We aimed to determine whether pre-hospital notification, introduction of a CT scanner near to assessment site and introduction of out-of-hours thrombolysis services affect thrombolysis timing. Methods Timings related to thrombolysis were collected between May 2012 and June 2014 at a single hospital site; these included time to stroke physician assessment, time to cranial CT imaging and door to needle time. All thrombolysed ischaemic stroke patients admitted via the emergency department were included. Ambulance services were asked to pre-notify the emergency department of any suspected stroke patient during this period. Results We studied 182 patients (48% female; mean age 74 years; 59% pre-notified). Pre-hospital notification was associated with a significantly higher rate of CT scanning within 25 minutes (60% vs 24%, odds ratio [OR] 4.7, 95% confidence interval [CI] 2.4–9.0; p<0.001), earlier stroke physician assessment (median 6 vs 32 minutes; p<0.001) and receiving thrombolysis within 60 minutes (89% vs 49%, OR 8.0, 95% CI 3.8–16.9; p<0.001). Being treated outside normal working hours did not alter thrombolysis timing. Logistic regression identified the introduction of a near-site CT scanner (OR 4.6 [95% CI 1.7–12.5]) and pre-hospital notification (OR 4.7, [95% CI 2.3–9.6]) as independent predictors of door to CT time ≤25 minutes, and pre-hospital notification (OR 11.6, [95% CI 4.9-30.3]) and stroke severity (OR 1.15 per point of NIHSS scale, [95% CI 1.08-1.23]) as predictors of door to thrombolysis time ≤60 minutes. The most common perceived timing delays were radiology-related (33%), the need to acutely lower blood pressure (15%) and obtaining consent (12%). Conclusion Pre-hospital notification is associated with earlier stroke physician review, CT imaging and delivery of thrombolysis. Referral to an out of hours thrombolysis service was not associated with additional delay.

KW - acute stroke

KW - ambulance services

KW - computed tomography

KW - pre-hospital notification

KW - thrombolysis

U2 - 10.4997/JRCPE.2015.303

DO - 10.4997/JRCPE.2015.303

M3 - Article

VL - 45

SP - 190

EP - 195

JO - Journal of the Royal College of Physicians of Edinburgh

JF - Journal of the Royal College of Physicians of Edinburgh

SN - 0035-8835

IS - 3

ER -