Article

This study examined the impact of a "direct potential thrombolysis"
pathway with direct admission to a neurological stroke unit (SU) on delays of
admission, stroke care and proportion of patients with ischemic stroke (IS)
treated with intravenous (IV) rtPA. METHODS: This prospective study included all
patients admitted in the intensive SU for potential thrombolysis over a 2-month
period. Data collected included the time of symptom onset, mode of transport,
National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of
care, delays of imaging and modalities, diagnosis and therapeutic data. RESULTS:
During the 2-month study period, 81 patients (mean age of 65 years) were included
in the study. The Emergency Medical Services (EMS) were involved in 86% of
admissions, with a median delay of admission of 1h48 and access within 4.5h in
84% of cases. Every patient underwent immediate neurovascular assessment and
imaging examination, which was a MRI in 80% of cases. Only 70% of patients had a
final diagnosis of stroke. Intravenous rtPA therapy was administered to 26
patients (32%), and 58% of patients with IS. The median door-to-needle time delay
was 63min. CONCLUSION: A direct 'potential thrombolysis' pathway, based on EMS
and located in the SU, can result in earlier admission, reaching the recommended
care delay, and a large proportion (58%) of IS patients receiving rtPA therapy.
On the other hand, the proportion of patients with stroke mimics is high, thereby
increasing the chances of intermittent periods of saturation of this specific
pathway.
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Langue : ANGLAIS