Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience
Journal
Arquivos de Neuro-Psiquiatria
ISSN
0004-282X
1678-4227
Date Issued
2023
Author(s)
Juan-Cristobal Nuñez
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Abstract</jats:title><jats:p>
Background The efficacy of intravenous thrombolysis (IVT) is time-dependent.</jats:p><jats:p>
Objective To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ≤ 20 minutes.</jats:p><jats:p>
Methods Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021.</jats:p><jats:p>
Results A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66–11.5, p = 0.004). In univariate analysis DTN time ≤ 20 minutes was associated with treatment by a SN (p = 0.002), coronavirus disease 2019 pandemic period (p = 0.21), time to emergency room (ER) (p = 0.21), presence of diabetes (p = 0.142), hypercholesterolemia (p = 0.007), atrial fibrillation (p < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) (p = 0.001), lower systolic (p = 0.143) and diastolic (p = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p = 0.09), vessel occlusion (p = 0.05), use of tenecteplase (p = 0.18), thrombectomy (p = 0.13), and years of experience of the physician (p < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44–10.8; p = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02–1.12; p < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96–0.99; p < 0.003) remained significant.</jats:p><jats:p>
Conclusion Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes.</jats:p>
Background The efficacy of intravenous thrombolysis (IVT) is time-dependent.</jats:p><jats:p>
Objective To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ≤ 20 minutes.</jats:p><jats:p>
Methods Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021.</jats:p><jats:p>
Results A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66–11.5, p = 0.004). In univariate analysis DTN time ≤ 20 minutes was associated with treatment by a SN (p = 0.002), coronavirus disease 2019 pandemic period (p = 0.21), time to emergency room (ER) (p = 0.21), presence of diabetes (p = 0.142), hypercholesterolemia (p = 0.007), atrial fibrillation (p < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) (p = 0.001), lower systolic (p = 0.143) and diastolic (p = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p = 0.09), vessel occlusion (p = 0.05), use of tenecteplase (p = 0.18), thrombectomy (p = 0.13), and years of experience of the physician (p < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44–10.8; p = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02–1.12; p < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96–0.99; p < 0.003) remained significant.</jats:p><jats:p>
Conclusion Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes.</jats:p>
Cite this document
Brunser, A. M., Nuñez, J.-C., Mansilla, E., Cavada, G., Olavarría, V., Muñoz Venturelli, P., & Lavados, P. M. (2023). Who is in the emergency room matters when we talk about door-to-needle time: A single-center experience. Arquivos de Neuro-Psiquiatria, 81(07), 624-631. https://doi.org/10.1055/s-0043-1768672
Subjects
fibrin clot lysis time thrombolytic
;
stroke
;
therapy
;
brain ischemia
;
covid-19
;
emergency service, hospital
;
fibrinolytic agents
;
humans
;
prospective studies
;
stroke
;
thrombolytic therapy
;
time-to-treatment
;
tissue plasminogen activator
;
treatment outcome
;
tenecteplase
;
fibrinolytic agent
;
tissue plasminogen activator
;
adult
;
aged
;
anterior cerebral artery
;
article
;
atrial fibrillation
;
blood clot lysis
;
blood pressure
;
blood vessel occlusion
;
brain hemorrhage
;
cerebrovascular accident
;
computer assisted tomography
;
coronavirus disease 2019
;
diabetes mellitus
;
diastolic blood pressure
;
emergency ward
;
female
;
human
;
hypercholesterolemia
;
major clinical study
;
male
;
middle aged
;
multivariate analysis
;
national institutes of health stroke scale
;
neurologist
;
physician
;
probability
;
prospective study
;
rankin scale
;
risk factor
;
systolic blood pressure
;
thrombectomy
;
univariate analysis
;
very elderly
;
brain ischemia
;
cerebrovascular accident
;
complication
;
coronavirus disease 2019
;
fibrinolytic therapy
;
hospital emergency service
;
procedures
;
time to treatment
;
treatment outcome