Limits...
Patient delay is the main cause of treatment delay in acute limb ischemia: an investigation of pre- and in-hospital time delay.

Londero LS, Nørgaard B, Houlind K - World J Emerg Surg (2014)

Bottom Line: It is important to identify existing problems in order to reduce time delay.We found that the largest time delay was between onset of symptoms and first contact to a medical doctor.A greater public awareness is needed, so as to facilitate urgent revascularisation and improve outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic- and Vascular Surgery, University Hospital of Odense, Sdr. Boulevard 29, 5000 Odense C, Denmark.

ABSTRACT

Background: The prognosis of acute limb ischemia is severe, with amputation rates of up to 25% and in-hospital mortality of 9-15%. Delay in treatment increases the risk of major amputation and may be present at different stages, including patient delay, doctors´ delay and waiting time in the emergency department. It is important to identify existing problems in order to reduce time delay. The aim of this study was to collect data for patients with acute limb ischemia and to evaluate the time delay between the different events from onset of symptoms to specialist evaluation and further treatment with focus on pre-hospital and in-hospital time delays.

Methods: We conducted a prospective cross-sectional cohort study including all patients suspected with acute limb ischemia who were admitted to the emergency department of a community hospital in a six months period. Temporal delay in the different phases between the time of occurrence of symptoms and completion of treatment was recorded prospectively. All patients who underwent intervention had a 30 days follow-up with regard to major amputation of the leg and survival.

Results: A total of 42 patients (21 men and 21 women) age 73 (20-95) years (median (range)) was identified. From onset of symptoms to first contact with a doctor the time for all patients were 24 (0-1200) hours. Thirty patients needed immediate intervention. In the group of fourteen patients who had immediate operation, the median time from vascular evaluation to revascularization was 324.5 (122-873) minutes and in the group of eight patients that went through an imaging procedure before an operation the median delay was 822 (494-1185) minutes from specialist assessment to revascularization. The median time for revascularization among four patients, who were treated with arterial thrombolysis was 5621 (1686-8376) minutes. At 30 days follow up, six patients had had the ischemic limb amputated above the ankle and four patients had died.

Conclusions: We found that the largest time delay was between onset of symptoms and first contact to a medical doctor. A greater public awareness is needed, so as to facilitate urgent revascularisation and improve outcomes.

No MeSH data available.


Related in: MedlinePlus

Distribution of patients. The distribution of patients (n = 42) according to levels of severity of acute limb ischemia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4232613&req=5

Fig1: Distribution of patients. The distribution of patients (n = 42) according to levels of severity of acute limb ischemia.

Mentions: A total of 42 patients (21 men and 21 women) ages 73 (20–95) years (median (range) were admitted on suspicion of ALI. Twenty-one patients (50%) had a prior history of vascular surgery for periphery arterial disease (PAD) in one or both legs. Twelve patients did either not have ALI or had ALI class 1, which did not need immediate intervention, and registration stopped after vascular examination. Of these patients three had deep venous thrombosis (DVT), one had neuropathic pain, seven had ALI class 1 and one had class 2A ischemia, but it was found that no immediate treatment was required. The distribution of patients according to levels of severity of acute limb ischemia is shown in Figure 1.Figure 1


Patient delay is the main cause of treatment delay in acute limb ischemia: an investigation of pre- and in-hospital time delay.

Londero LS, Nørgaard B, Houlind K - World J Emerg Surg (2014)

Distribution of patients. The distribution of patients (n = 42) according to levels of severity of acute limb ischemia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232613&req=5

Fig1: Distribution of patients. The distribution of patients (n = 42) according to levels of severity of acute limb ischemia.
Mentions: A total of 42 patients (21 men and 21 women) ages 73 (20–95) years (median (range) were admitted on suspicion of ALI. Twenty-one patients (50%) had a prior history of vascular surgery for periphery arterial disease (PAD) in one or both legs. Twelve patients did either not have ALI or had ALI class 1, which did not need immediate intervention, and registration stopped after vascular examination. Of these patients three had deep venous thrombosis (DVT), one had neuropathic pain, seven had ALI class 1 and one had class 2A ischemia, but it was found that no immediate treatment was required. The distribution of patients according to levels of severity of acute limb ischemia is shown in Figure 1.Figure 1

Bottom Line: It is important to identify existing problems in order to reduce time delay.We found that the largest time delay was between onset of symptoms and first contact to a medical doctor.A greater public awareness is needed, so as to facilitate urgent revascularisation and improve outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic- and Vascular Surgery, University Hospital of Odense, Sdr. Boulevard 29, 5000 Odense C, Denmark.

ABSTRACT

Background: The prognosis of acute limb ischemia is severe, with amputation rates of up to 25% and in-hospital mortality of 9-15%. Delay in treatment increases the risk of major amputation and may be present at different stages, including patient delay, doctors´ delay and waiting time in the emergency department. It is important to identify existing problems in order to reduce time delay. The aim of this study was to collect data for patients with acute limb ischemia and to evaluate the time delay between the different events from onset of symptoms to specialist evaluation and further treatment with focus on pre-hospital and in-hospital time delays.

Methods: We conducted a prospective cross-sectional cohort study including all patients suspected with acute limb ischemia who were admitted to the emergency department of a community hospital in a six months period. Temporal delay in the different phases between the time of occurrence of symptoms and completion of treatment was recorded prospectively. All patients who underwent intervention had a 30 days follow-up with regard to major amputation of the leg and survival.

Results: A total of 42 patients (21 men and 21 women) age 73 (20-95) years (median (range)) was identified. From onset of symptoms to first contact with a doctor the time for all patients were 24 (0-1200) hours. Thirty patients needed immediate intervention. In the group of fourteen patients who had immediate operation, the median time from vascular evaluation to revascularization was 324.5 (122-873) minutes and in the group of eight patients that went through an imaging procedure before an operation the median delay was 822 (494-1185) minutes from specialist assessment to revascularization. The median time for revascularization among four patients, who were treated with arterial thrombolysis was 5621 (1686-8376) minutes. At 30 days follow up, six patients had had the ischemic limb amputated above the ankle and four patients had died.

Conclusions: We found that the largest time delay was between onset of symptoms and first contact to a medical doctor. A greater public awareness is needed, so as to facilitate urgent revascularisation and improve outcomes.

No MeSH data available.


Related in: MedlinePlus