1. Stroke Angel: Effect of Telemedical Prenotification on In-Hospital Delays and Systemic Thrombolysis in Acute Stroke Patients
- Author
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Eder, Patrick Andreas, Laux, Gunter, Rashid, Asarnusch, Kniess, Tobias, Haeusler, Karl Georg, Shammas, Layal, Griewing, Bernd, Hofmann, Susanne, Stangl, Stephanie, Wiedmann, Silke, Rücker, Viktoria, Heuschmann, Peter U., Soda, Hassan, and Stroke Angel Study Group
- Subjects
Male ,medicine.medical_specialty ,Telemedicine ,Emergency Medical Services ,Time Factors ,medicine.medical_treatment ,Acute ischemic stroke ,Emergency Nursing ,Risk Assessment ,Intravenous thrombolysis ,Time-to-Treatment ,Fibrinolytic Agents ,Risk Factors ,Germany ,Emergency medical services ,Medicine ,Humans ,Thrombolytic Therapy ,Neurologists ,Prospective Studies ,Stroke ,Acute stroke ,Aged ,Ischemic Stroke ,Aged, 80 and over ,Patient Care Team ,business.industry ,Audit ,Thrombolysis ,Middle Aged ,medicine.disease ,Treatment Outcome ,Neurology ,Emergency medicine ,Cohort ,Observational study ,Administration, Intravenous ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit ,Program Evaluation - Abstract
Introduction: Door-to-CT scan time (DCT) and door-to-needle time (DNT) are important process measures in acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis (IVT). We examined the impact of a telemedical prenotification by emergency medical service (EMS) (called the “Stroke Angel” program) on DCT and DNT and IVT rate compared to standard of care. Patients and Methods: Two prospective observational studies including AIS patients admitted via EMS from 2011 to 2013 (cohort I; n = 496) and from January 1, 2015 to May 31, 2018 (cohort II; n = 349) were conducted. After cohort I, the 4-Item Stroke Scale and a digital thrombolysis protocol were added. Multivariable logistic and linear regression analysis was performed. Results: In cohort I, DCT was lower in the intervention group (13 vs. 26 min using standard of care; p < 0.001), but no significant difference in median DNT (35 vs. 39 min; p = 0.24) was observed. In cohort II, a reduction of DCT (8 vs. 15 min; p < 0.001) and DNT (25 vs. 29 min p = 0.003) was observed in the intervention group. Compared to standard of care, the likelihood of DCT ≤10 min or DNT ≤20 min in the intervention group was 2.7 (adjusted odds ratio [aOR] 2.7; 95% CI: 2.1–3.5) and 1.8 (aOR 1.8; 95% CI: 1.1–2.9), respectively. In cohort II, IVT rate was higher (aOR 1.4; 95% CI: 1.1–1.9) in the intervention group. Conclusion: Although the positive effects of Stroke Angel in AIS provided a rationale for implementation in routine care, larger studies of practice implementation will be needed. Using Stroke Angel in the prehospital management of AIS impacts on important process measures of IVT delivery.
- Published
- 2020