The effectiveness of decision aids for intravenous thrombolysis in the emergency green channel: A non-randomized...

To explore the effectiveness of the self-developed intravenous thrombolysis (IVT) decision aids (DAs) in patients with acute ischemic stroke (AIS) in the emergency green channel.

Delayed consent is a significant barrier to IVT in patients with AIS. The diversity and benefits of DAs have been well-documented. However, their real-world effectiveness may depend on tool content and usage context. Therefore, the development of new DAs is strongly justified.

A non-randomized controlled trial as a quality improvement project, which was not registered.

Consecutive AIS patients receiving IVT in the emergency department of a tertiary Grade-A hospital in Beijing, China, were prospectively enrolled via convenience sampling from May to August 2024. They were divided into groups based on the time of admission. The control group (n = 79, from May to June 2024) used the traditional green channel protocol, while the intervention group (n = 55, from July to August 2024) applied the self-developed DAs as well as the traditional green channel protocol. Differences in door-to-needle time (DNT), the DNT ≤ 45 min compliance rate, National Institutes of Health Stroke Scale (NIHSS) scores, and satisfaction scores were compared between the two groups. Subgroup analyses were conducted based on NIHSS score groups (≤3 and ≥ 4). Linear regression was employed to analyze factors influencing DNT and satisfaction scores in the intervention group.

The intervention group had superior DNT and the DNT ≤ 45 min compliance rate versus controls (all P < 0.05), while satisfaction and 1-h post-thrombolysis NIHSS scores showed no intergroup differences (all P > 0.05). Subgroup analyses revealed that in patients with NIHSS ≥ 4, the DNT difference between intervention and control groups was significant (P < 0.05). Additionally, Linear regression showed a significant correlation between satisfaction and NIHSS scores (β = 0.266, P < 0.05).

The self-developed DAs significantly shortened DNT and improved treatment efficiency in patients with AIS, without increasing staff burden, with enhanced benefits in high-NIHSS scores (≥4) patients. Higher NIHSS scores were associated with greater patient satisfaction.