Pre-hospital screening of stroke patients for thrombolysis reduces delay to CT scanning and treatment

Kwan, J., Marigold, R., South, A. and Hennesey, N. (2010) Pre-hospital screening of stroke patients for thrombolysis reduces delay to CT scanning and treatment. International Journal of Stroke, 5 (3), [007]. (doi:10.1111/j.1747-4949.2010.00492.x).

Abstract

Introduction: for stroke thrombolysis, reducing the delay to CT scanning and treatment is crucial in maximising the potential benefit of the treatment. We explored the effects of pre-hospital screening of stroke patients for thrombolysis and direct door-to-CT protocol on delays in CT scanning and treatment.

Method: since 8/2009, paramedics in Bournemouth began using a new protocol of on-scene FAST and ROSIER scoring plus screening patients for eligibility for thrombolysis. Potentially eligible patients were taken directly to the CT scanner on arrival; neurological assessment took place after CT scan. We compared door-to-CT (D-CT) and door-to-needle (D-N) delays since the introduction of the new protocol, exploring any differences between those arriving within office hours (Monday-Friday 9am–5pm) and outside office hours.

Results: between 8/2009–2/2010, 22 patients were thrombolysed within office hours (9 via new protocol, 13 via traditional protocol) - new protocol patients had significantly lower median D-CT delay (10 vs. 45 min) and D-N delay (40 vs. 113 min). In the same period, 12 patients were thrombolysed outside office hours (5 via new protocol, 7 via traditional protocol) – new protocol patients had significantly lower median D-CT delay (30 vs. 75 min) and D-N delay (65 vs. 95 min). These results compared favourably with UK overall (D-CT 32 min, D-N 65 min), and international centres overall (D-CT 24 min, D-N 65 min). No inappropriate transfer was identified.

Conclusion: pre-hospital screening of stroke patients for thrombolysis and direct door-to-CT protocol can significantly reduce delay to CT and treatment, both within and outside office hours.

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