The relationship between factors and good neurological outcomes in acute ischemic stroke patients treated with rt-PA in the fast track pathway and referred for further treatment at the emergency room of Debaratana Nakhon Ratchasima Hospital
Keywords:
Stroke Fast Track, Referral system, rt-PAAbstract
Background
The Stroke Fast Track referral network has advanced patient access to acute stroke treatment, but various factors continue to affect outcomes, especially the timely administration of recombinant tissue plasminogen activator (rt-PA).
Objective
To assess factors associated with favorable neurological outcomes at discharge in acute ischemic stroke patients who received rt-PA through the Stroke Fast Track system at Debaratana Nakhon Ratchasima Hospital’s Emergency Department.
Methods
This retrospective study included patients with acute ischemic stroke who received rt-PA via the Stroke Fast Track referral network from October 1, 2019, to September 30, 2023.
Results
Among 211 patients treated with rt-PA after referral, the majority were female with a mean age of 61 years (range, 23–92), with 26% under 55 years. Hypertension was the most prevalent comorbidity, along with smoking (9%) and atrial fibrillation (8%). Average times were 2.44 hours from symptom onset to hospital arrival, 5.56 minutes from hospital arrival to computerized tomography (CT), 35.61 minutes to scan interpretation, and 44.79 minutes to rt-PA administration. Favorable neurological outcomes were observed in 66.4% (140 patients). Multivariable logistic regression showed that age (Adjusted OR 0.685, 95% CI 0.514–0.913, p=0.010) and National Institutes of Health Stroke Scale (NIHSS) scores (Adjusted OR 0.216, 95% CI 0.106–0.443, p<0.001) were significant predictors of favorable outcomes. Patients younger than 55 years and those with lower NIHSS scores had higher likelihoods of favorable outcomes. Factors like atrial fibrillation, body mass index, and consciousness level were significant in univariable analysis but not in the multivariable model.
Conclusion
Age and NIHSS score are key predictors of favorable neurological outcomes in acute ischemic stroke patients treated with rt-PA in the emergency setting.
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บทความที่ได้รับตีพิมพ์ในวารสารเวชศาสตร์ฉุกเฉินแห่งประเทศไทย ถือเป็นเป็นลิขสิทธิ์ของ วิทยาลัยแพทย์เวชศาสตร์ฉุกเฉินแห่งประเทศไทย
กรณีที่บทความได้รับการตีพิมพ์ในวารสารเวชศาสตร์ฉุกเฉินแห่งประเทศไทยแล้ว จะตีพิมพ์ในรูปแบบอิเล็กทรอนิกส์ ไม่มีสำเนาการพิมพ์ภายหลังหนังสือเผยแพร่เรียบร้อยแล้ว ผู้นิพนธ์ไม่สามารถนำบทความดังกล่าวไปนำเสนอหรือตีพิมพ์ในรูปแบบใดๆ ที่อื่นได้ หากมิได้รับคำอนุญาตจากวารสารเวชศาสตร์ฉุกเฉินแห่งประเทศไทย
