The use of a pre-hospital questionnaire expedited the acute management of patients with ischemic stroke in a comprehensive stroke center.

Publication Title

Clinical neurology and neurosurgery

Authors

V Montalvan, Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United State
G Neves, Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
J Shannon, Department of Pulmonology and Critical Care Medicine. Covenant Medical Center, Lubbock, TX, United StatesFollow
T Clifford, Covenant Direct Regional Transfer Center, Covenant Medical Center, Lubbock, TX, United StatesFollow
J Curry
C Kahathuduwa, Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States
Y Tan, Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
R Barnes
J Kopel
Laxmi Chintakayala
R Brister
S Hancock, Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.Follow
A Baugham, Department of Neurology. Covenant Medical Center, Lubbock, TX, United StatesFollow
K Hendley, Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.Follow
N Bhatt
R Pollard

Document Type

Article

Publication Date

9-1-2024

Keywords

Humans; Ischemic Stroke; Male; Female; Aged; Middle Aged; Emergency Medical Services; Thrombolytic Therapy; Time-to-Treatment; Surveys and Questionnaires; Cohort Studies; Fibrinolytic Agents; Aged, 80 and over; Acute stroke; Emergency Medical Services; Thrombolysis; Time-to-Treatment.; texas; covenant

Abstract

BACKGROUND: Delays in intravenous thrombolysis (IVT) treatment for acute ischemic stroke decrease the benefit of treatment. Difficulties determining a patient's clinical eligibility for IVT is a frequent cause of treatment delays.

OBJECTIVE: We aimed to assess the effectiveness of the "PROVIDENCE" datasheet, a pre- hospital assessment of contraindications for IVT use applied by emergency medical services personnel.

METHODS: We performed a single-center cohort study comparing IVT decision and treatment times between patients with PROVIDENCE datasheets and those without. Patients were eligible if they were over 18 years old and presented to our comprehensive stroke center from the field with stroke-like symptoms with onset within 4.5 hours.

RESULTS: We identified 465 records and included 166 records in our final analysis (54 in the study group and 112 in the control group). A subgroup of 85 patients received IVT (30 in the study group patients and 55 in the control group). The PROVIDENCE datasheet was associated with a faster median time by five minutes from the patient's initial presentation at the emergency department to the final decision regarding IVT eligibility (p = 0.032) and a faster time between the first encounter with a neurology provider and the decision regarding IVT administration by six minutes (p = 0.002) for the entire sample. In the subgroup that received IVT, the PROVIDENCE datasheet decreased the median decision time by seven minutes (p = 0.044) There was no significant difference in door-to-needle times between groups.

CONCLUSION: Using the PROVIDENCE datasheet, first responders can quickly identify potential contraindications for IVT treatment in patients with stroke-like symptoms. This tool expedited decision-making and led to faster IVT administration process at a comprehensive stroke center.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Critical Care Medicine

Specialty/Research Institute

Emergency Medicine

DOI

10.1016/j.clineuro.2024.108442