Systematic review of stroke thrombolysis service configuration

被引:34
作者
Price, Christopher I. [1 ]
Clement, Fiona [2 ]
Gray, Joanne [2 ]
Donaldson, Cam [3 ]
Ford, Gary A. [4 ]
机构
[1] Wansbeck Gen Hosp, Ashington NE63 9JJ, Northumberland, England
[2] Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne NE2 4AA, Tyne & Wear, England
[3] Newcastle Univ, Inst Hlth & Soc, Epidemiol & Publ Hlth, Newcastle Upon Tyne NE2 4AA, Tyne & Wear, England
[4] Newcastle Tyne NHS Fdn Trust, Clin Res Ctr, Royal Victoria Infirm, Clin Pharmacol,Inst Ageing & Hlth, Newcastle Upon Tyne NE1 4LP, Tyne & Wear, England
基金
美国国家卫生研究院;
关键词
emergency medical service; health service; stroke; stroke center; thrombolytic therapy; tissue plasminogen activator; TISSUE-PLASMINOGEN ACTIVATOR; ACUTE ISCHEMIC-STROKE; EMERGENCY-DEPARTMENT EVALUATION; INTRAVENOUS THROMBOLYSIS; TIME WINDOW; TPA THERAPY; CARE; TELESTROKE; EXPERIENCE; COMMUNITY;
D O I
10.1586/14737175.9.2.211
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Intravenous recombinant tissue plasminogen activator is a highly effective treatment for acute ischemic stroke, but routine provision is challenging. We compared the activity, safety and response times of five service configurations: local services, redirection of selected or all suspected stroke patients by emergency medical services (EMS) to stroke centers and the use of telemedicine with and without secondary transfer to a stroke center. In total, 59 relevant service descriptions were identified. Pooled treatment rates (mean +/- standard deviation [SD]) per 100 confirmed stroke patients were: local service design, 2.5 +/- 2.5 (n = 21417); EMS redirection of only patients potentially eligible for thrombolysis, 3.9 +/- 1.2 (n = 1872); EMS redirection of all suspected stroke patients, 3.8 +/- 1.1 (n = 5427); telemedicine with secondary transfer, 6.9 (no pooled SD; n = 749); and telemedicine without secondary transfer, 3.4 (no pooled SD; n = 6610). A comprehensive stroke patient register was completed for only five regional collaborations, resulting in pooled ischemic stroke treatment rates of 5.7(95% confidence interval: 4.6-6.9; n = 7815) compared with 3.1 (95% confidence interval: 2.1-4.1; n = 31411) for local services. Pooled symptomatic hemorrhage rates were similar for all service designs (range: 3.9-5.1%). Average door needle times exceeded 60 min in most studies. We conclude that regional collaborations achieve higher rates of thrombolysis than local services working in isolation. Stroke services should continue to publish thrombolysis activity and safety data in a recommended format in order to determine the most suitable configuration for different settings.
引用
收藏
页码:211 / 233
页数:23
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