Abstract
Pre-hospital notification enhances thrombolysis rate and improves intra-hospital delays, but the impact of the notification to the neurologist by the emergency medical system (EMS) call centre remains unknown. Our objective was to compare pre-hospital and in-hospital delays in stroke patients treated by intravenous recombinant tissue plasminogen activator (rt-PA), with and without pre-hospital notification. We compared baseline characteristics and in-hospital delays in stroke patients treated by rt-PA with a high-level notification (call to EMS and EMS–neurologist discussion), a low-level notification (call to EMS without EMS–neurologist discussion ) and no pre-hospital notification. Of 302 consecutive patients [165 women, 54.6 %; median age 74 years, interquartile range (IQR) 59–83], patients with high-level, low-level and no notification differed for the severity at admission (median National Institutes of Health Stroke Scale scores, respectively, of: 12, IQR 7–17; 9, IQR 6–15, and 8, IQR 6–14, p = 0.029). Patients with high-level notification had shorter (1) admission-to-completion of imaging times (27 min, IQR 14–35) than patients with low-level notification (35 min, IQR 17–54) or no notification (36 min, IQR 30–58) (p < 0.01); (2) door-to-needle times (49 min, IQR 39–62 vs. 57 min, IQR 39–81 vs. 63 min, IQR 51–97; p = 0.003); and (3) onset-to-needle times (140 min, IQR 110–175 vs. 155 min, IQR 106–230 vs. 182 min, IQR 131–234; p < 0.001). They did not differ for onset-to-admission time and imaging-to-needle time. Pre-hospital notification by the EMS reduces intra-hospital delays in patients eligible for rt-PA, but the benefit is higher in the case of discussion between the EMS and the neurologist before admission.
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Acknowledgments
We are grateful to Anne-Marie Bordet for her help in monitoring the data. Funds received from University Lille Nord de France (EA 1046), and Adrinord. Dr Casolla Barbara was funded by a Research Fellowship for Young Investigators, granted in 2011 by the Italian Foundation Umberto Veronesi.
Conflicts of interest
Barbara Casolla, Eric Wiel and Patrick Goldstein: none. Marie Bodenant and Jean-Pierre Pruvo are investigators of DIAS 3 (Lundbeck) and Thrace (French Ministry of Health). Charlotte Cordonnier, Marie Girot, and Didier Leys were investigators of ECASS 3 (Boehringer-Ingelheim), and are investigators of DIAS 3 (Lundbeck) and Thrace (French Ministry of Health).
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All human studies must state that they have been approved by the approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
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Casolla, B., Bodenant, M., Girot, M. et al. Intra-hospital delays in stroke patients treated with rt-PA: impact of preadmission notification. J Neurol 260, 635–639 (2013). https://doi.org/10.1007/s00415-012-6693-1
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DOI: https://doi.org/10.1007/s00415-012-6693-1