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Delayed Intravenous Thrombolysis in Patients with Minor Stroke

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Author(s)
Jeong-Ho HongJaseong KooYoung Dae KimJaehyuk KwakHyo Suk NamJi Hoe HeoKijeong LeeJang-Hyun BaekKyoungsub KimJoonsang YooSung-Il SohnJinkwon KimSeong Hwan Ahn
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Cerebrovascular Diseases
Issued Date
2018
Volume
46
Issue
1-2
Keyword
Ischemic strokeThrombolysisQuality assessmentEmergency departmentAcute stroke therapyTissue plasminogen activator
Abstract
Background:
The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient’s stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA).

Methods:
We included consecutive patients who received IV tPA during a 1.5 year-period in 5 hospitals. Minor stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score<5. We compared various intervals from arrival at the ED to treatment between patients with minor stroke and those with non-minor stroke (NIHSS score ≥5). Delayed treatment was defined as a door-to-needle time >40 min.

Results:
During the study period, 356 patients received IV tPA treatment. The median door-to-needle time was significantly longer in the minor stroke group than it was in the non-minor stroke group (43 min [interquartile range [IQR] 35.5–55.5] vs. 37 min [IQR 30–46], p < 0.001). The minor stroke group had a significantly longer door-to-notification time (7 min [IQR 4.5–12] vs. 5 min [IQR 3–8], p < 0.001) and door-to-imaging time(20 min [IQR 15–26.5] vs. 16 min [IQR 11–21], p < 0.001) than did the non-minor stroke group. However, the imaging-toneedle time was not different between the groups. Multivariable analyses revealed that minor stroke was associated with delayed treatment (OR 2.54 [95% CI 1.52–4.30], p =0.001).

Conclusions:
Our findings show that the door-toneedle time was longer in patients with minor stroke than it was in those with non-minor stroke, mainly owing to delayed action in the initial steps of neurology notification and imaging. Our findings suggest that some quality improvement initiatives are necessary for patients with suspected stroke with minor symptoms.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Citation
Jeong-Ho Hong et al. (2018). Delayed Intravenous Thrombolysis in Patients with Minor Stroke. Cerebrovascular Diseases, 46(1–2), 52–58. doi: 10.1159/000492123
Type
Article
ISSN
1421-9786
Source
https://www.karger.com/Article/Abstract/492123
DOI
10.1159/000492123
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41753
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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