Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Pre-hospital management of acute stroke patients eligible for thrombolysis - an evaluation of ambulance on-scene time

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Patient experience of spinal immobilisation after trauma

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Impact of caller's degree-of-worry on triage response in out-of-hours telephone consultations: a randomized controlled trial

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Medical dispatchers' perception of visual information in real out-of-hospital cardiac arrest: a qualitative interview study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  5. Traumatic brain injury is associated with increased syndecan-1 shedding in severely injured patients

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Patient experience of spinal immobilisation after trauma

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Do callers to out-of-hours care misuse an option to jump the phone queue?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Impact of caller's degree-of-worry on triage response in out-of-hours telephone consultations: a randomized controlled trial

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Vis graf over relationer

BACKGROUND: Stroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component. We aimed to analyse ambulance OST in stroke patients eligible for thrombolysis and identify potential areas of time optimization.

METHODS: A study-specific registration form was developed to record detailed information about OST consumption in cases where the Emergency Medical Services (EMS) suspected a stroke from July 2014-May 2015. Registration forms were completed by ambulance personnel and included details on estimated time spent: 1) localising patient, 2) clinical examination, 3) consulting with the on-call neurologist, 4) mobilising patient to the ambulance, 5) treatment in ambulance before departure. Additionally, estimated total OST was noted. For patients found eligible for further evaluation at a stroke centre, time points were analysed using multivariate Poisson regressions.

RESULTS: A total of 520 cases were included. The median OST was 21 min (Interquartile Range (IQR) 16-27). Time consumption was significantly lower (17 vs 21 min, p = 0.0015) when electrocardiography (ECG) was obtained in-hospital instead of on-scene, when intravenous (IV) access was established during transportation instead of before transportation (17 vs 21 min, p < 0.0001), and when the quality of communication with the stroke centres was rated as "good" as opposed to "acceptable/poor" (21 vs 23 min, p = 0.014). Neither the presence of relatives nor ambulance trainees had a significant effect on OST.

CONCLUSIONS: In-hospital ECG recording and IV cannulation during transport were found to reduce OST, while "acceptable/poor" communication was found to prolong OST relative to "good" communication. These components of pre-hospital stroke management represent potential opportunities for lowering OST with relatively simple changes, which could ultimately lead to earlier treatment and better patient outcome.

TRIAL REGISTRATION: Unique identifier: NCT02191514 .

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Vol/bind27
Udgave nummer1
Sider (fra-til)3
ISSN1757-7241
DOI
StatusUdgivet - 9 jan. 2019

ID: 56196167