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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Stroke pathway performance assessment: a retrospective observational study.

Jacopo Camporesi1, Silvia Strumia2, Andrea Di Pilla3,4

  • 1Intensive Care Unit (ICU) Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy.

BMC Health Services Research
|December 11, 2023
PubMed
Summary
This summary is machine-generated.

This study assessed the Italian Stroke Pathway's performance from 2010-2020, finding improved Door-To-Needle times and outcomes, even during COVID-19. Further improvements in pre-hospital care and earlier thrombolysis are recommended.

Keywords:
COVID-19Performance assessmentPharmacological thrombolysisStroke pathway

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Area of Science:

  • Neurology
  • Public Health
  • Healthcare Quality Improvement

Background:

  • Stroke Pathway performance is crucial for healthcare quality.
  • This study retrospectively assessed an Italian Stroke Pathway's temporal trends and COVID-19 pandemic impact.

Purpose of the Study:

  • To evaluate the Stroke Pathway's performance over time.
  • To analyze the impact of the COVID-19 pandemic on stroke care processes and patient outcomes.

Main Methods:

  • Retrospective observational study (2010-2020) of ischemic stroke patients receiving intravenous thrombolysis.
  • Analysis of patient demographics, baseline severity scores (mRS, NIHSS), and time metrics (OTD, DTI, DTN).
  • Comparison of pre-COVID-19 (2019) and early pandemic (2020) periods.

Main Results:

  • Increased patient age and baseline disability over time.
  • Significant reduction in Door-To-Needle (DTN) times (90 to 61 min) and increased 'golden hour' thrombolysis.
  • Despite pandemic challenges, hospital process times (DTI, DTN) and clinical outcomes remained stable; pre-hospital Onset-to-Door (OTD) times increased.

Conclusions:

  • The Stroke Pathway demonstrates positive impacts on hospital processes and patient outcomes, meeting international goals, even during the COVID-19 pandemic.
  • Identified need for improvements in both hospital and pre-hospital phases.
  • Recommendations include initiating thrombolysis in diagnostic imaging departments and promoting public health education on stroke recognition and emergency services.