Document Type : Short Communication
1 Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Student Research Committee, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Background: According to the American Heart Association and American Stroke Association (AHA/ASA) guidelines, in acute stroke, the door-to-computed tomography (CT) scan (DTC) time should be less than 25 minutes, and time to injection of recombinant tissue-type plasminogen activator (r-tPA) [door-to-needle (DTN) time] should be less than 60 minutes.
Methods: We had a tendency to prospectively collect the clinical and time information of patients who received r-tPA during one year after the initiation of prehospital notification (PN). Patients were divided into three groups, covering patients transferred by Emergency Medical Service (EMS) with and without PN, and non-EMS. We then contrasted the impact of EMS with PN and EMS use on onset-to-needle time (ONT), and the neurological outcome. Good outcome was determined as Modified Rankin Scale (MRS) ≤ 2 at 3-month follow-up.
Results: Among 102 studied patients, 64% were transferred by EMS, of whom 53.9% entered PN. Compared with non-PN groups, EMS with PN group showed significantly shorter DTN and DTC time, as well as ONT.
Conclusion: Our study showed that EMS with PN, rather than EMS, significantly improved stroke outcome by shortening of ONT.
- Sadeghi-Hokmabadi E, Yazdchi M, Farhoudi M, Sadeghi H, Taheraghdam A, Rikhtegar R, et al. Prognostic factors in patients with acute ischemic stroke treated with intravenous tissue plasminogen activator: The first study among Iranian patients. Iran J Neurol 2018; 17(1): 31-7.
- Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: An updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375(9727): 1695-703.
- Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV, et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011; 123(7): 750-8.
- Borhani HA, Karimi AA, Amiri A, Ghaffarpasand F. Knowledge and attitude towards stroke risk factors, warning symptoms and treatment in an Iranian population. Med Princ Pract 2010; 19(6): 468-72.
- Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44(3): 870-947.
- Sheppard JP, Mellor RM, Greenfield S, Mant J, Quinn T, Sandler D, et al. The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. Emerg Med J 2015; 32(2): 93-9.
- Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: A systematic review. Neurology 2014; 82(24): 2241-9.
- National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333(24): 1581-7.
- van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19(5): 604-7.
- Zhang S, Zhang J, Zhang M, Zhong G, Chen Z, Lin L, et al. Prehospital notification procedure improves stroke outcome by shortening onset to needle time in Chinese urban area. Aging Dis 2018; 9(3): 426-34.