Impact of emergency fast track on treatment time and outcomes in acute stroke: a systematic review and meta-analysis.

Abstract

Objective: To systematically evaluate the effectiveness of emergency fast track in improving the efficiency of acute stroke management and enhancing clinical outcomes, thereby providing evidence-based support for optimizing emergency care workflows.

Methods: A comprehensive literature search was conducted in CNKI, Wanfang Data, VIP Database, PubMed, Embase, Web of Science, and the Cochrane Library to identify studies on the application of emergency fast track in acute stroke. Data synthesis was performed using Review Manager 5.4 software. The primary measures included pre-hospital waiting time, time from hospital admission to diagnosis, time from diagnosis to treatment, length of stay in the emergency fast track, rescue success rate, and patient satisfaction rate. Sensitivity analysis was used to assess the robustness of the results, and publication bias was evaluated using Begg's and Egger's tests.

Results: A total of 30 studies were included. The meta-analysis indicated that emergency fast track significantly reduced pre-hospital waiting time (MD = - 4.65, 95% CI: - 5.76 to - 3.53), time from hospital admission to diagnosis (MD = - 8.13, 95% CI: - 9.32 to - 6.93), time from diagnosis to treatment (MD = - 10.95, 95% CI: - 12.32 to - 9.59), and emergency fast track duration (MD = - 7.47, 95% CI: - 9.30 to - 5.64), while significantly increasing the rescue success rate (OR = 5.71, 95% CI: 4.48 to 7.27). Most outcomes showed no significant publication bias, and sensitivity analyses confirmed the stability of the results.

Conclusion: The emergency fast-track protocol significantly reduces critical timeframes in acute/critical care pathways, including: pre-hospital delay, door-to-imaging time, imaging-to-treatment interval, and fast-track dwell time. Concurrently, it enhances the rescue success rate (proportion of successfully stabilized patients). These demonstrated clinical benefits support its widespread implementation in stroke emergency systems. Further validation through multicenter high-quality trials is recommended to establish efficacy generalizability.

Clinical trial number: Not applicable.