Impact of a novel pre-hospital stroke notification programme on acute stroke care key performance indicators in Hong Kong: a multicentre prospective cohort study with historical controls.

IF 3.1 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Hong Kong Medical Journal Pub Date : 2024-04-01 Epub Date: 2024-04-05 DOI:10.12809/hkmj2210413
K Y Cheng, E L M Yu, T Yamamoto, J C L Kwong, Y K Ho, H K Ngan, W H Lin, J M T Lau, C H Cheung, G P C Lee, L H Siu, B Sheng, W W Y Wong, W Y Man, C C C Cheung, C T Tse
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引用次数: 0

Abstract

Introduction: Early identification and initiation of reperfusion therapy is essential for suspected acute ischaemic stroke. A pre-hospital stroke notification (PSN) protocol using FASE (facial drooping, arm weakness, speech difficulties, and eye palsy) was implemented to improve key performance indicators (KPIs) in acute stroke care delivery. We assessed KPIs and clinical outcomes before and after PSN implementation in Hong Kong.

Methods: This prospective cohort study with historical controls was conducted in the Accident and Emergency Departments of four public hospitals in Hong Kong. Patients were screened using the PSN protocol between August 2021 and February 2022. Suspected stroke patients between August 2020 and February 2021 were included as historical controls. Door-to-needle (DTN) and door-to-computed tomography (DTC) times before and after PSN implementation were compared. Clinical outcomes including National Institutes of Health Stroke Scale score at 24 hours and modified Rankin Scale score at 3 months after intravenous recombinant tissue-type plasminogen activator (IV-rtPA) were also assessed.

Results: Among the 715 patients (266 PSN and 449 non-PSN) included, 50.8% of PSN patients and 37.7% of non-PSN patients had a DTC time within 25 minutes (P<0.001). For the 58 PSN and 134 non-PSN patients given IV-rtPA, median DTN times were 67 and 75.5 minutes, respectively (P=0.007). The percentage of patients with a DTN time within 60 minutes was higher in the PSN group than in the non-PSN group (37.9% vs 21.6%; P=0.019). No statistically significant differences in clinical outcomes were observed.

Conclusion: Although the PSN protocol shortened DTC and DTN times, clinical outcomes did not significantly differ.

新型院前卒中通报计划对香港急性卒中救治关键绩效指标的影响:一项多中心前瞻性队列研究与历史对照。
简介早期识别和启动再灌注治疗对疑似急性缺血性卒中至关重要。为改善急性卒中救治的关键绩效指标(KPIs),我们实施了院前卒中通知(PSN)方案,采用 FASE(面部下垂、手臂无力、言语困难和眼球麻痹)。我们评估了 PSN 在香港实施前后的关键绩效指标和临床结果:这项前瞻性队列研究在香港四家公立医院的急诊科进行。在 2021 年 8 月至 2022 年 2 月期间,采用 PSN 方案对患者进行筛查。2020年8月至2021年2月期间的疑似中风患者作为历史对照。比较了 PSN 实施前后的 "门到针"(DTN)和 "门到计算机断层扫描"(DTC)时间。此外,还评估了临床结果,包括美国国立卫生研究院卒中量表 24 小时评分和静脉注射重组组织型纤溶酶原激活剂(IV-rtPA)后 3 个月的修正 Rankin 量表评分:结果:在纳入的 715 名患者(266 名 PSN 患者和 449 名非 PSN 患者)中,50.8% 的 PSN 患者和 37.7% 的非 PSN 患者的 DTC 时间在 25 分钟以内(PC 结论:虽然 PSN 方案缩短了 DTC 时间,但并没有缩短患者的 DTC 时间:尽管 PSN 方案缩短了 DTC 和 DTN 时间,但临床结果并无显著差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hong Kong Medical Journal
Hong Kong Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.50
自引率
14.80%
发文量
117
审稿时长
10 weeks
期刊介绍: The HKMJ is a Hong Kong-based, peer-reviewed, general medical journal which is circulated to 6000 readers, including all members of the HKMA and Fellows of the HKAM. The HKMJ publishes original research papers, review articles, medical practice papers, case reports, editorials, commentaries, book reviews, and letters to the Editor. Topics of interest include all subjects that relate to clinical practice and research in all branches of medicine. The HKMJ welcomes manuscripts from authors, but usually solicits reviews. Proposals for review papers can be sent to the Managing Editor directly. Please refer to the contact information of the Editorial Office.
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