Pre- and In-Hospital Management of Stroke

Abstract

Background: For acute ischemic stroke (AIS), intravenous thrombolysis (IVT) is an effective but time-dependent therapy. However, patients are usually too late for treatment, mainly because of preand in-hospital delays. Method: Papers were identified through the PubMed search, with keywords such as: ‘stroke’, ‘thrombolysis’, ‘management’, ‘prehospital delay’, ‘in-hospital delay’. Results: In pre-hospital stroke management, factors related to pre-hospital delays include demographic characteristics, social factors, clinical factors, behavioral factors, and cognitive factors. Great significance should be assigned to the implementation of stroke preparedness interventions, stroke assessment instruments, the use of emergency medical service (EMS), mobile stroke units (MSUs), and the Stroke Emergency Map. With regard to in-hospital stroke management, there are some tasks related to the inhospital delays, such as registering patients, waiting for the stroke team, CT availability, lab resources, and making a decision for thrombolytic therapy. With good communication between the EMS and the emergency department (ED), delays can be significantly reduced. Conclusions: With the streamlining of all aspects of prehospital and in-hospital thrombolysis processes and the increase of hospital experience, we can achieve a shorter onset-to-treatment time (OTT), and more patients may benefit from timely thrombolytic therapy.