Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Prompt administration of tissue plasminogen activator is crucial for treating ischemic stroke.
• Existing strategies aim to reduce the time from patient arrival to treatment (door-to-needle time).
• The availability of stroke neurologists can impact treatment timeliness.

Purpose of the Study:

• To evaluate an emergency physician-based protocol for acute ischemic stroke care.
• To assess the protocol's impact on door-to-needle time when a stroke neurologist is unavailable.
• To analyze changes in treatment delays, hemorrhage rates, and patient outcomes.

Main Methods:

• Retrospective before-and-after analysis of an urban hospital's stroke treatment process.
• Implementation of an emergency physician-directed protocol in 2013.
• Multivariable linear regression used to compare door-to-needle times before and after the intervention.

Main Results:

• Median door-to-needle time decreased from 54 minutes to 20 minutes post-intervention (difference of 32 minutes).
• Median onset-to-treatment time decreased from 135 minutes to 119 minutes.
• Symptomatic intracerebral hemorrhage rates remained similar (4.7% vs. 2.2%), and approximately 70% of patients achieved functional independence after reorganization.

Conclusions:

• An emergency physician-led stroke protocol effectively reduces treatment delays for acute ischemic stroke.
• This strategy improves efficiency without compromising patient safety regarding hemorrhage risk.
• The protocol demonstrates a successful approach to acute stroke care in resource-variable settings.