Abstract WP397: CT Stroke Code Dramatically Reduces Door-to-needle and Door-to-groin Times for Reperfusion Therapy
Background and aim: Shortening door-to-needle (DTN) time is one of the major goals of reperfusion therapy. Several strategies have been proposed to shortening DTN including fast track emergency room (ER) protocols, and tPA administration in the CT suit. A comprehensive Stroke Code (SC) pre-notification leading to a direct transfer of patients to the CT suit, bypassing ER, may dramatically reduce DNT. To ensure quality of care, and continuity of care in this process, the role of an expert stroke nurse may also be essential. We aimed to assess the impact of SC and direct transfer to CT (CT-SC) on DTN and door-to-groin (DTG) time and to evaluate the role of an expert stroke nurse to ensures the continuity of patient′s care from admission.
Methods: Forty-four CT-SC patients were compared to 81 contemporary SC patients who underwent reperfusion treatment first evaluated at ER. Once CT-SC was activated, and information provided was clear, patient was directly transfer from ambulance to CT. An expert stroke unit nurse wait for the patient in the CT suit. If SC was not activated, patient unstable or information was incomplete or unclear, the patient was first transfer to the ER before CT. Clinical data and response times were evaluated. The primary outcome was the reduction of DTN time to <20minuntes, and DTG to <60min, and secondary outcome security (Symptomatic ICH and mortality) and feasibility (lack of incidents) of the CT-SC protocol.
Results: In the CT-SC group 52.2% patients were treated in <20min vs 5.4% in the SC group (p<0.001). CS-CT protocol significantly reduces DTG times, as DTG was shorter in the CS-CT group (n=11; 64.7%) compared to CS group (n=6; 16.7%), p=0.001. Regarding security of the protocol, no differences were found between groups: SICH was present in 3 (3%) patents in CS group, and in 3 (9%) patients in CT-SC group; Seven patients (8.6%) died in CS group, and 2 patients (6,2%) in CT-SC group. Regarding feasibility no major incidents were found in the stroke unit while expert nurse was attending a CS-CT patient. Nurse mean time out of the stroke unit was 28+/-12min.
Conclusions: CT-SC protocol markedly reduces DTN and DTG times, increasing the number of patients treated bellow <20 and <60 minutes time-window respectively. Moreover, CT-SC seems to be feasible and safe.
Author Disclosures: E. Sanjuan: None. M. Rubiera: None. K.E. Santana: None. P. Giron: None. M. Muchada: None. S. Boned: None. M. Ribo: None. D. Rodriguez-Luna: None. J. Pagola: None. M. Sanchis: None. J. Juega: None. A.A. Flores: None. C.A. Molina: None.
- © 2016 by American Heart Association, Inc.