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Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco. Ann Glob Health 2020; 86:83. [PMID: 32742941 PMCID: PMC7380055 DOI: 10.5334/aogh.2885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients. Objective: The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco. Methods: This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke. Findings: A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI95%: 1.08–3.44) primary education (OR 3.43; CI95%: 1.63–7.21), rural residential (OR 1.67; CI95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4). Conclusions: The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.
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Abstract
BACKGROUND In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change. PURPOSE We aimed to (1) compare prehospital delay times-the time from symptom onset to hospital arrival-between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex. METHODS The CINAHL, MEDLINE, PubMed, Scopus, and PsycINFO databases were searched using PRISMA guidelines. Inclusion criteria were as follows: (1) quantitative research articles published between May 2008 and April 2019, (2) investigation of prehospital delay among women and men 15 years or older who were given a diagnosis of acute stroke or transient ischemic attack, and (3) English-language publications. The Crowe Critical Appraisal Tool was used to evaluate the quality of studies. RESULTS Fifteen publications (n = 162 856) met inclusion criteria. Most studies (n = 11) showed no sex differences in prehospital delay. Four studies from Asian-Pacific countries and the United States showed that women had significantly longer prehospital delay compared with men. Older age, minority race/ethnicity (black and Mexican American), and underuse of emergency medical services were associated with prolonged prehospital delay in women. CONCLUSIONS Most study authors found no differences in prehospital delay between women and men; however, women delayed longer in some Asian-Pacific and American studies. Findings of sex differences were inconclusive.
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Prehospital stroke management in the thrombectomy era. Lancet Neurol 2020; 19:601-610. [DOI: 10.1016/s1474-4422(20)30102-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
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Darehed D, Blom M, Glader EL, Niklasson J, Norrving B, Eriksson M. In-Hospital Delays in Stroke Thrombolysis: Every Minute Counts. Stroke 2020; 51:2536-2539. [PMID: 32586222 DOI: 10.1161/strokeaha.120.029468] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis is a well-established treatment for acute ischemic stroke. Our aim was to quantify the effect of each minute delay in door-to-needle time (DNT) on 90-day survival, intracerebral hemorrhagic complication <36 hours, and functional outcomes at 3 months, in routine clinical practice. METHODS Our nationwide registry-based study included 14 132 adult patient admissions with ischemic stroke receiving intravenous thrombolysis from 2010 to 2017. Outcomes were analyzed using multivariable logistic regression, adjusting for potential confounders. RESULTS Median DNT was 47 minutes, with an improvement from 65 to 38 minutes during the study. Median age was 74 years, and median National Institutes of Health Stroke Scale 8 points. We found a significant impact of each minute delay in DNT with reduced odds of survival by 0.6%, increased odds of intracerebral hemorrhagic and worse activities of daily living by 0.3%, and worse living conditions and mobility by 0.4%. CONCLUSIONS Improving DNT is a key factor in achieving good outcomes after stroke. We estimate that in Sweden alone in 2017, compared with 2010, the shorter DNT achieved have saved 38 lives, avoided 8 intracerebral hemorrhagic transformations, and spared, respectively, 36, 51, and 52 patients from a worsening in activities of daily living, living conditions, and mobility. DNT is sensitive for interventions and should be targeted in quality improvement efforts.
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Affiliation(s)
- David Darehed
- Department of Public Health and Clinical Medicine (D.D.), Umeå University, Sweden
| | - Mathias Blom
- Department of Clinical Sciences Lund, Medicine (M.B.), Lund University, Sweden
| | - Eva-Lotta Glader
- Sunderby Research Unit, Department of Public Health and Clinical Medicine, Medicine (E.-L.G.), Umeå University, Sweden
| | - Johan Niklasson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine (J.N.), Umeå University, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Skåne University Hospital (B.N.), Lund University, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics and Statistics (M.E.), Umeå University, Sweden
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Trends in Endovascular Mechanical Thrombectomy in Treatment of Acute Ischemic Stroke in the United States. World Neurosurg 2020; 138:e839-e846. [DOI: 10.1016/j.wneu.2020.03.105] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/23/2022]
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Khalil HM, Lahoud N. Knowledge of Stroke Warning Signs, Risk Factors, and Response to Stroke among Lebanese Older Adults in Beirut. J Stroke Cerebrovasc Dis 2020; 29:104716. [PMID: 32192843 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104716] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke is a global burden. In Lebanon, recent studies have shown that stroke prevalence may be higher than other developing countries. While older people are particularly vulnerable to stroke, research suggests that they have poor stroke awareness. Since awareness is crucial for early hospital admission, thereby outcome, the main objectives of this study were to assess knowledge of stroke ie, symptoms, risk factors, and intended behavior in case of stroke suspicion. METHODS A community-based survey targeting adults aged 50 and above was conducted at 20 random pharmacies in Beirut from May to October 2018 through face to face interviews utilizing a structured questionnaire composed of open and closed ended questions. Descriptive and multivariable analyses were performed. MAIN RESULTS In total, 390 participants completed the questionnaire. Sixty-eight percent were able to spontaneously recall at least 1 stroke symptom, most frequently headache (29.2%), hemiparesis (25.4%), and dizziness (19.5%). Furthermore, 85.4% spontaneously recalled at least 1 risk factor, most frequently hypertension (48.2%), smoking (20.5%), and stress (43.1%). In case of stroke suspicion 57.69% would call an ambulance. Knowing a stroke patient and educational level were predictors for recall of more symptoms and risk factors for stroke. Adequate response to stroke was positively associated with identification of more stroke symptoms but inversely associated with having diabetes. CONCLUSIONS AND RECOMMENDATIONS There are major gaps in stroke knowledge among Beirut's older population. Culturally tailored awareness campaigns should be implemented at multiple levels using different media methods to target vulnerable populations at higher risk for stroke and their families. These campaigns should focus on improving stroke symptoms awareness and actions to take when suspecting stroke.
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Affiliation(s)
| | - Nathalie Lahoud
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon; Faculty of Public Health, Lebanese University, Fanar, Lebanon; CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon; INSPECT-LB, Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Fanar, Lebanon
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Fladt J, Meier N, Thilemann S, Polymeris A, Traenka C, Seiffge DJ, Sutter R, Peters N, Gensicke H, Flückiger B, de Hoogh K, Künzli N, Bringolf-Isler B, Bonati LH, Engelter ST, Lyrer PA, De Marchis GM. Reasons for Prehospital Delay in Acute Ischemic Stroke. J Am Heart Assoc 2019; 8:e013101. [PMID: 31576773 PMCID: PMC6818040 DOI: 10.1161/jaha.119.013101] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion-weighted magnetic resonance imaging, symptom onset within 24 hours and hospitalized in the Stroke Center of the University Hospital Basel, Switzerland. Trained study nurses interviewed patients and proxies along a standardized questionnaire. Prehospital delay was defined as >4.5 hours between stroke onset-or time point of wake-up-and admission. Overall, 336 patients were enrolled. Prehospital delay was observed in 140 patients (42%). The first healthcare professionals to be alarmed were family doctors for 29% of patients (97/336), and a quarter of these patients had a baseline National Institute of Health Stroke Scale score of 4 or higher. The main modifiable risk factor for prehospital delay was a face-to-face visit to the family doctor (adjusted odds ratio, 4.19; 95% CI, 1.85-9.46). Despite transport by emergency medical services being associated with less prehospital delay (adjusted odds ratio, 0.41; 95% CI, 0.24-0.71), a minority of patients (39%) who first called their family doctor were transported by emergency medical services to the hospital. The second risk factor was lack of awareness of stroke symptoms (adjusted odds ratio, 4.14; 95% CI, 2.36-7.24). Conclusions Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging-confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02798770.
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Affiliation(s)
- Joachim Fladt
- Department of Neurology University Hospital Basel Basel Switzerland
| | | | | | | | - Christopher Traenka
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland
| | - David J Seiffge
- Department of Neurology University Hospital Basel Basel Switzerland
| | - Raoul Sutter
- Department of Neurology University Hospital Basel Basel Switzerland.,Department of Intensive Care Medicine University Hospital Basel Basel Switzerland.,University of Basel Switzerland
| | - Nils Peters
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland.,University of Basel Switzerland
| | - Henrik Gensicke
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland.,University of Basel Switzerland
| | - Benjamin Flückiger
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Bettina Bringolf-Isler
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Leo H Bonati
- Department of Neurology University Hospital Basel Basel Switzerland.,University of Basel Switzerland
| | - Stefan T Engelter
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland.,University of Basel Switzerland
| | - Philippe A Lyrer
- Department of Neurology University Hospital Basel Basel Switzerland.,University of Basel Switzerland
| | - Gian Marco De Marchis
- Department of Neurology University Hospital Basel Basel Switzerland.,University of Basel Switzerland
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Wenderoth J, McAuliffe W, Coulthard A, Mitchell P, Arthur A, Fraser JF, McConachie N, Clifton A, Flynn P, Crossley R, Brouwer P, Kulscar Z, Fiehler J. The Role of Interventional Radiologists in Acute Stroke Interventions: A Joint Statement from the Australia and New Zealand Society of Neuroradiology (ANZSNR), the Society of Neurointerventional Surgery (SNIS), the United Kingdom Neurointerventional Group (UKNG), the British Society of Neuroradiology (BSNR), and the European Society for Minimally Invasive, Neurological Therapy (ESMINT). J Vasc Interv Radiol 2019; 30:1400-1403. [DOI: 10.1016/j.jvir.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
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Haworth D, McClelland G. Call to hospital times for suspected stroke patients in the North East of England: a service evaluation. Br Paramed J 2019; 4:31-36. [PMID: 33328834 PMCID: PMC7706759 DOI: 10.29045/14784726.2019.09.4.2.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Stroke is a leading cause of mortality and morbidity. The role of the ambulance service in acute stroke care focuses on recognition followed by rapid transport to specialist care. The treatment options for acute ischaemic strokes are time dependent, so minimising the pre-hospital phase of care is important. The aim of this service evaluation was to report historical pre-hospital times for suspected stroke patients transported by the North East Ambulance Service NHS Foundation Trust (NEAS) and identify areas for improvement. Methods: This was a retrospective service evaluation using routinely collected data. Data on overall call to hospital times, call to arrival times, on scene times and leave scene to hospital are reported. Results: Data on 24,070 patients with an impression of stroke transported by NEAS between 1 April 2011 and 31 May 2018 are reported. The median call to hospital time increased from 41 to 68 minutes, call to arrival from 7 to 17 minutes, on scene from 20 to 30 minutes and leave to hospital from 12 to 15 minutes. Conclusion: The pre-hospital call to hospital time for stroke patients increased between 2011 and 2018. The call to arrival phase saw a sharp increase between 2015 and 2017, whereas on scene and leave scene to hospital saw steadier increases. Increasing demand on the ambulance service, reorganisation of regional stroke services and other factors may have contributed to the increase in times. Reducing the on scene phase of pre-hospital stroke care would lead to patient benefits and is the area where ambulance clinicians have the most influence.
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Affiliation(s)
- Daniel Haworth
- North East Ambulance Service NHS Foundation Trust: ORCID iD: https://orcid.org/0000-0003-0334-3300
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust: ORCID iD: https://orcid.org/0000-0002-4502-5821
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McVerry F, Hunter A, Dynan K, Matthews M, McCormick M, Wiggam I, Vahidassr D, McErlean F, Stevenson M, Hopkins E, McKee J, Kelly J, Kennedy F, McCarron MO. Country-Wide Analysis of Systemic Factors Associated With Acute Ischemic Stroke Door to Needle Time. Front Neurol 2019; 10:676. [PMID: 31297081 PMCID: PMC6606974 DOI: 10.3389/fneur.2019.00676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/10/2019] [Indexed: 01/19/2023] Open
Abstract
Objective: Pre-hospital, in-hospital, and patient factors are associated with variation in door to needle (DTN) time in acute ischemic stroke (AIS). Publications are usually from large single centers or multicenter registries with less reporting on national results. Materials and methods: All AIS patients treated with intravenous tissue plasminogen activator (iv-tPA) over 4 years (2013–2016) in Northern Ireland were recorded prospectively, including patient demographics, pre-hospital care, thrombolysis rate, and DTN time. Logistic regression was performed to identify factors associated with DTN time. Results: One thousand two hundred and one patients from 10,556 stroke admissions (11.4%) were treated with iv-tPA. Median NIHSS was 10 (IQR 6-17). Median DTN time was 54 min (IQR 36-77) with 61% treated < 60 min from arrival at hospital. National thrombolysis numbers increased over time with improving DTN time (P = 0.002). Arrival method at hospital (ambulance OR 2.3 CI1.4-3.8) pre-alert from ambulance (pre-alert OR = 5.3 CI3.5-8.1) and time of day (out of hours, n = 650, OR 0.20 CI 0.22-0.38) all P < 0.001, were the independent factors in determining DTN time. Variation in DTN time between centers occurred but was unrelated to volume of stroke admissions. Conclusion: Ambulance transport with pre-hospital notification and time of day are associated with shorter DTN time on a national level. Most thrombolysis was delivered outside of normal working hours but these patients are more likely to experience treatment delays. Re-organization of stroke services at a whole system level with emphasis on pre-hospital care and design of stroke teams are required to improve quality and equitable care in AIS nationally.
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Affiliation(s)
- Ferghal McVerry
- Stroke Unit and Neurology Department, Altnagelvin Hospital, Derry, United Kingdom
| | - Annemarie Hunter
- Neurology Department, Royal Victoria Hospital, Belfast, United Kingdom
| | - Kevin Dynan
- Stroke Unit, Ulster Hospital, Dundonald, United Kingdom
| | | | | | - Ivan Wiggam
- Neurology Department, Royal Victoria Hospital, Belfast, United Kingdom
| | | | - Fintan McErlean
- Audit Department, Royal Victoria Hospital, Belfast, United Kingdom
| | - Mike Stevenson
- Centre for Public Health, Queen's University, Belfast, United Kingdom
| | - Emer Hopkins
- Health and Social Care Board, Belfast, United Kingdom
| | - Jacqueline McKee
- Stroke Unit and Neurology Department, Altnagelvin Hospital, Derry, United Kingdom
| | - James Kelly
- Stroke Unit, South West Acute Hospital, Enniskillen, United Kingdom
| | - Fiona Kennedy
- Neurology Department, Royal Victoria Hospital, Belfast, United Kingdom
| | - Mark O McCarron
- Stroke Unit and Neurology Department, Altnagelvin Hospital, Derry, United Kingdom
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Hou X, Chen W, Xu H, Zhu Z, Xu Y, Chen H. The rate of early neurological deterioration occurring after thrombolytic therapy: A meta-analysis. Brain Behav 2019; 9:e01210. [PMID: 30632308 PMCID: PMC6379592 DOI: 10.1002/brb3.1210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/06/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The rate of early neurological deterioration (END) occurring after thrombolytic therapy is controversial. To explore a more precise estimation of the rate, a meta-analysis was conducted in the present study. METHODS The relevant studies were identified by searching PubMed, EMBASE, and Cochrane Collaboration Database up to June 2018. The definition of END was prespecified according to the most commonly used definition: ≥4-point increase in National Institutes of Health Stroke Scale between admission and 24 hr. The meta-analysis was performed by using the STATA 12. RESULTS Eleven studies with a total of 3,539 subjects, including 373 patients with END and 3,166 patients without END, were collected. The pooled analysis showed that the rate of END occurring after thrombolytic therapy was about 11.0% (95% CI: 7.8%-14.3%). Subgroup analysis by continent showed that the rate of END occurring after thrombolytic therapy of patients in Asia (15.9%, 95% CI: 7.4%-24.5%) was higher than in Europe (7.6%, 95% CI: 4.9%-10.3%) and in North America (11.8%, 95% CI: 8.5%-15.0%). Subgroup analysis by onset to treatment time (OTT) displayed that the rate of END occurring after thrombolytic therapy was 5.4% (95% CI: 1.2%-9.5%), 15.6% (95% CI: 9.6%-21.5%), and 18.5% (95% CI: 11.2%-25.8%) for the patients whose OTT ≤120.0 min, from 120.1 to 179.9 min, from 180.0 to 270.0 min, respectively. CONCLUSION The rate of END occurring after thrombolytic therapy is about 11.0%. This finding may provide a scientific reference for researchers to evaluate the efficacy and safety of thrombolytic therapy.
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Affiliation(s)
- Xiaowen Hou
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China.,Group of Chronic Disease and Environmental Genomics, China Medical University, Shenyang, China
| | - Wanli Chen
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China
| | - Haibin Xu
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China
| | - Zhi Zhu
- School of Materials Science and Engineering, Shenyang Aerospace University, Shenyang, China
| | - Yuanyuan Xu
- Group of Chronic Disease and Environmental Genomics, China Medical University, Shenyang, China
| | - Huisheng Chen
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China
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Schlemm L. Disability Adjusted Life Years due to Ischaemic Stroke Preventable by Real-Time Stroke Detection-A Cost-Utility Analysis of Hypothetical Stroke Detection Devices. Front Neurol 2018; 9:814. [PMID: 30327638 PMCID: PMC6174318 DOI: 10.3389/fneur.2018.00814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Ischaemic stroke remains a significant contributor to permanent disability world-wide. Therapeutic interventions for acute ischaemic stroke (AIS) are available, but need to be administered early after symptom onset in order to be effective. Currently, one of the main factors responsible for poor clinical outcome is an unnecessary long time between symptom onset and arrival at a hospital (pre-hospital delay). In the future, technological devices with the capability of real-time detection of AIS may become available. The health economic implications of such devices have not been explored. Methods: We developed a novel probabilistic model to estimate the maximally allowable annual costs of different hypothetical real-time AIS detection devices in different populations given currently accepted willingness-to-pay thresholds. Distributions of model parameters were extracted from the literature. Effectiveness of the intervention was quantified as reduction in disability-adjusted life-years associated with faster access to thrombolysis and mechanical thrombectomy. Incremental costs were calculated from a societal perspective including acute treatment costs and long-term costs for nursing care, home help, and loss of production. The impact of individual model parameters was explored in one-way and multi-way sensitivity analyses. Results: The model yields significantly shorter prehospital delays and a higher proportion of acute ischaemic patients that fulfill the time-based eligibility criteria for thrombolysis or mechanical thrombectomy in the scenario with a real-time stroke detection device as compared to the control scenario. Depending on the sociodemographic and geographic characteristics of the study population and operating characteristics of the device, the maximally allowable annual cost for the device to operate in a cost-effective manner assuming a willingness-to-pay threshold of GBP 30.000 ranges from GBP 22.00 to GBP 9,952.00. Considering the results of multiway sensitivity analyses, the upper bound increases to GBP 29,449.10 in the subgroup of young patients with a very high annual risk of ischaemic stroke (50 years/20% annual risk). Conclusion: Data from probabilistic modeling suggest that real-time AIS detection devices can be expected to be cost-effective only for a small group of highly selected individuals.
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Affiliation(s)
- Ludwig Schlemm
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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63
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Hassankhani H, Soheili A, Vahdati SS, Mozaffari FA, Fraser JF, Gilani N. Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review. Ann Emerg Med 2018; 73:118-129. [PMID: 30318375 DOI: 10.1016/j.annemergmed.2018.08.435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/11/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED). METHODS A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification. Primary outcomes were identified treatment delays and causes of loss of eligibility for intravenous recombinant tissue plasminogen activator (r-tPA). RESULTS Of patients with acute ischemic stroke, 80.2% did not meet intravenous r-tPA eligibility; the most common cause was delayed (>4.5 hours) ED arrival after symptom onset (71.82%; n=283). Of 19.8% of subjects for whom the stroke code was activated, intravenous r-tPA was administered in only 5.3%. The average time from patients' arrival to first emergency medicine resident visit, notification of acute stroke team, presence of neurology resident, and computed tomography scan interpretation was lower for patients who met criteria of intravenous r-tPA than for those who lost eligibility for fibrinolytic therapy. The average door-to-needle time was 69 minutes (interquartile range 46 to 91 minutes). CONCLUSION Our ED and acute stroke team had a favorable clinical performance meeting established critical time goals of inhospital care for potentially eligible patients, but a poor clinical performance for the majority of patients who were not candidates for fibrinolytic therapy.
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Affiliation(s)
- Hadi Hassankhani
- Research Center for Evidence-Based Medicine, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Soheili
- Student Research Committee, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Samad S Vahdati
- Neurosciences Research Center, Department of Emergency Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farough A Mozaffari
- Department of Social Sciences, School of Law and Social Sciences, University of Tabriz, Tabriz, Iran
| | - Justin F Fraser
- Department of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, KY
| | - Neda Gilani
- Road Traffic Injury Research Center, Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Online Information about Stroke - A Soft Challenge for Critical Care Professionals. ACTA ACUST UNITED AC 2018; 4:147-148. [PMID: 30574568 PMCID: PMC6296278 DOI: 10.2478/jccm-2018-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
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Zhao J, Eckenhoff MF, Sun WZ, Liu R. Stroke 112: A Universal Stroke Awareness Program to Reduce Language and Response Barriers. Stroke 2018; 49:1766-1769. [PMID: 29925649 DOI: 10.1161/strokeaha.118.021729] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To improve stroke awareness and reduce life-threatening prehospital delays worldwide, a universal stroke educational program is needed. To meet this unmet need, we developed a universal program without language barriers and tested its acceptance in Taiwan, where Chinese is the native language. METHODS Stroke 112 was developed using the universal emergency phone number, 112. The numbers imply an emergency and correspond to the 3 stroke recognition signs used in FAST (Face, Arm, Speech, and Time): 1 uneven face (crooked mouth); 1 weak arm (arm weakness); 2 incoherent lips (slurred speech). An online survey was used to determine the acceptance of the Stroke 112 program compared with that of FAST in Chinese. The surveys were delivered using SurveyMonkey (http://www.surveymonkey.com) on 2 separate occasions in Taiwan; in August 2017 for an initial estimation of the acceptance of Stroke 112 and in March 2018, 2 weeks after the official release of Stroke 112 in Taiwan, including a special introductory lecture for neurologists hosted by the STARS-Taiwan (Stroke Treatment and Research Society-Taiwan). RESULTS The initial survey with 465 survey responders, 54.6% thought that Stroke 112 was easier to remember for people in Taiwan compared with FAST (41.2%). After Stroke 112's official release in Taiwan, 610 individuals completed the survey, and the majority (66.4%) thought that Stroke 112 was easier to remember, a significant increase compared with the initial survey (P=0.0001). Among the 130 neurologists who attended the Stroke 112 introductory lecture, 55 completed the online survey. A greater acceptance of Stroke 112 (74.6%) compared with FAST (16.4%) was observed among these 55 neurologists (P=0.0001). CONCLUSIONS Stroke 112, a universal stroke educational program without language barriers was developed. It could potentially be implemented worldwide, especially where 112 is used as an emergency phone number.
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Affiliation(s)
- Jing Zhao
- From the Department of Neurology, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, China (J.Z.)
| | - Maryellen F Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia (M.F.E., R.L.)
| | - Wei-Zen Sun
- Center of Emergency Medicine Research (W.-Z.S.) and Department of Anesthesiology (W.-Z.S.), National Taiwan University Medical School, Taiwan
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia (M.F.E., R.L.)
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Biousse V, Nahab F, Newman NJ. Management of Acute Retinal Ischemia: Follow the Guidelines! Ophthalmology 2018; 125:1597-1607. [PMID: 29716787 DOI: 10.1016/j.ophtha.2018.03.054] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 11/24/2022] Open
Abstract
Acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment. Guidelines recommend the combination of urgent brain magnetic resonance imaging with diffusion-weighted imaging, vascular imaging, and clinical assessment to identify TMVL, BRAO, and CRAO patients at highest risk for recurrent stroke, facilitating early preventive treatments to reduce the risk of subsequent stroke and cardiovascular events. Because the risk of stroke is maximum within the first few days after the onset of visual loss, prompt diagnosis and triage are mandatory. Eye care professionals must make a rapid and accurate diagnosis and recognize the need for timely expert intervention by immediately referring patients with acute retinal arterial ischemia to specialized stroke centers without attempting to perform any further testing themselves. The development of local networks prompting collaboration among optometrists, ophthalmologists, and stroke neurologists should facilitate such evaluations, whether in a rapid-access transient ischemic attack clinic, in an emergency department-observation unit, or with hospitalization, depending on local resources.
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Affiliation(s)
- Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
| | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
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