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Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment.

Simonsen SA, Andresen M, Michelsen L, Viereck S, Lippert FK, Iversen HK - Scand J Trauma Resusc Emerg Med (2014)

Bottom Line: Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001).In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001).Response time, but not total alarm-to-door time, was reduced during the five years.

View Article: PubMed Central - PubMed

Affiliation: Glostrup Stroke Centre, Department of Neurology, Glostrup Hospital, Copenhagen University Hospital, Nordre ringvej 57, Glostrup, 2600, Denmark. sofie.a.s@gmail.com.

ABSTRACT

Background: Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.

Methods: We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch of the ambulance to arrival at the scene, on-scene time and transport time to the hospital-in total, alarm-to-door time. In addition, we noted baseline characteristics.

Results: We reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33-52), of which 18 (12-24) minutes were spent on scene. Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001). In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001).

Conclusions: This study shows an unchanged alarm-to-door time of 41 minutes over a five-year period. Response time, but not total alarm-to-door time, was reduced during the five years. On-scene time constituted nearly half of the total alarm-to-door time and is thus a point of focus for improvement.

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Box plot of the alarm-to-door time in minutes and postal code areas. Area 1: <10 km from stroke centre, area 2: 11–30 km from stroke centre, area 3: 31–50 km from stroke centre, area 4: >50 km from stroke centre. NA represents a group where the pick-up location could not be determined. The NA group does not differ significantly from postal area group 1. Note the difference between group 3 and 4 (see Discussion).
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Fig4: Box plot of the alarm-to-door time in minutes and postal code areas. Area 1: <10 km from stroke centre, area 2: 11–30 km from stroke centre, area 3: 31–50 km from stroke centre, area 4: >50 km from stroke centre. NA represents a group where the pick-up location could not be determined. The NA group does not differ significantly from postal area group 1. Note the difference between group 3 and 4 (see Discussion).

Mentions: We find a significant association between alarm-to-door time and age (p <0.001 and adj. R2 = 0.03) and, as expected, alarm-to-door time and postal code area (p <0.001 and adj. R2 = 0.26), though only the distance to the hospital really contributes to the variance in alarm-to-door time (summarized in Figures 3 and 4).Figure 3


Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment.

Simonsen SA, Andresen M, Michelsen L, Viereck S, Lippert FK, Iversen HK - Scand J Trauma Resusc Emerg Med (2014)

Box plot of the alarm-to-door time in minutes and postal code areas. Area 1: <10 km from stroke centre, area 2: 11–30 km from stroke centre, area 3: 31–50 km from stroke centre, area 4: >50 km from stroke centre. NA represents a group where the pick-up location could not be determined. The NA group does not differ significantly from postal area group 1. Note the difference between group 3 and 4 (see Discussion).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233232&req=5

Fig4: Box plot of the alarm-to-door time in minutes and postal code areas. Area 1: <10 km from stroke centre, area 2: 11–30 km from stroke centre, area 3: 31–50 km from stroke centre, area 4: >50 km from stroke centre. NA represents a group where the pick-up location could not be determined. The NA group does not differ significantly from postal area group 1. Note the difference between group 3 and 4 (see Discussion).
Mentions: We find a significant association between alarm-to-door time and age (p <0.001 and adj. R2 = 0.03) and, as expected, alarm-to-door time and postal code area (p <0.001 and adj. R2 = 0.26), though only the distance to the hospital really contributes to the variance in alarm-to-door time (summarized in Figures 3 and 4).Figure 3

Bottom Line: Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001).In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001).Response time, but not total alarm-to-door time, was reduced during the five years.

View Article: PubMed Central - PubMed

Affiliation: Glostrup Stroke Centre, Department of Neurology, Glostrup Hospital, Copenhagen University Hospital, Nordre ringvej 57, Glostrup, 2600, Denmark. sofie.a.s@gmail.com.

ABSTRACT

Background: Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.

Methods: We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch of the ambulance to arrival at the scene, on-scene time and transport time to the hospital-in total, alarm-to-door time. In addition, we noted baseline characteristics.

Results: We reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33-52), of which 18 (12-24) minutes were spent on scene. Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001). In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001).

Conclusions: This study shows an unchanged alarm-to-door time of 41 minutes over a five-year period. Response time, but not total alarm-to-door time, was reduced during the five years. On-scene time constituted nearly half of the total alarm-to-door time and is thus a point of focus for improvement.

Show MeSH
Related in: MedlinePlus