Thai Journal of Emergency Medicine

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

Alisara Kavilo — 2025-07-21

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.

Effects of online lesson on knowledge and triage quality among nurse in the emergency department.

Preeyanan Seebao — 2025-07-21

Background
Since elderly people tend to receive an inaccurate triage. The promotion of nurses' knowledge in understanding the aging process, characteristics of elderly people, geriatric syndromes, and triaging skills for the elderly patients may help increase the triage accuracy and reduce the adverse effects consequently.
Objectives
To compare the knowledge and accuracy of triage for the elderly patients among nurses in the emergency department at baseline, the 4-week and the 8-week follow-up. Method: The one-group repeated-measures design was studied with 21 accident and emergency nurses of Roi-et Hospital between July to November, 2023. The research instruments were an online learning lesson and manual. Data were collected through the questionnaire, the knowledge measurement form, and the quality assessment form for triage of elderly patients. The continuous data were analysed using descriptive statistics. Repeated measure ANOVA was to analyse the average score of knowledge.

Results
1) The average knowledge scores of the accident and emergency nurses increased significantly from the baseline, after the 4-week and the 8-week follow up (F=1317.57, df = 1, p<.001). 2) The comparison of the accuracy of triage for the elderly patients between the baseline and the 8-week follow-up showed differences. The accuracy of elderly patients' triage triage has also increased from 71.9 96 to 80.0 %.
Conclusion
This online learning lesson can increase emergency nurses' knowledge and increasing the triage quality of elderly patients to be more accurate. This online learning lesson could be a quideline for further developing knowledge and skills for accident and emergency nurses.

The Impact of Emergency Medical Services on the Treatment Outcomes of Stroke Patients Receiving the rt-PA Administration

Nattaporn Paesuwan — 2025-07-21

Introduction
Emergency Medical Services (EMS) aim to provide timely and effective treatment to patients. Research has shown that acute ischemic stroke patients who EMS transfers often experience shorter reperfusion times and better clinical outcomes. This study aims to investigate these effects in our specific setting.
Objective
To evaluate the impact of Emergency Medical Services (EMS) on the clinical outcomes of ischemic stroke patients who receive rt-PA
Methods
This is a retrospective study that collects data from medical records between January 1, 2016, and December 31, 2023. It compares clinical outcomes and survival rates between stroke patients who were transferred by Emergency Medical Services (EMS group) and those who were not (non-EMS group). Data analysis will be conducted using multiple logistic regression, with a significance level set at <0.05
Results
This study included 214 patients, with a majority being men (52.8%) and a mean age of 62.1 years (standard deviation 13.8 years). Of these, 52 were in the EMS group, while 162 were in the non-EMS group. Patients in the EMS group were more likely to achieve a door-to-needle time of less than 45 and 60 minutes, with odds ratios of 3.91 and 2.73, respectively. However, survival rates and improvements in other clinical outcomes were not significantly different between the two groups.
Conclusion
EMS improves door-to-needle time for stroke patients receiving rt-PA but does not significantly impact other clinical outcomes

Comparison of efficacy outcomes of video-based learning and traditional face-to-face learning of intraosseous catheterization in Thai medical interns educated abroad

Busakorn Thamsathira — 2025-07-21

Introduction
Intraosseous catheterization is an essential procedure for physicians in emergency care. It was traditionally taught through face-to-face practical training, but there is now an increasing use of video media in the education of medical interns.
Objectives
This study compares the effectiveness of learning intraosseous catheterization through video-based learning and traditional face-to-face learning, and to assess the effectiveness of video-based learning over a four-week period.
Method
This research is designed as a prospective study and a randomized controlled trial. It was conducted among Thai interns who graduated from international institutions and underwent training at Lerdsin Hospital, with data collected from June 1, 2023 to November 1, 2023. Fifty nine participants were included in the study, divided into two groups: Group V (video-based learning) with 29 participants, and Group T (face-to-face learning) with 30 participants. Both groups were evaluated through pre-test and post-test with multiple-choice tests, post-test practical examinations, satisfaction surveys, and a follow-up assessment conducted four weeks after the training. The quality of the test items was assessed using Index of Item-Objective Congruence.
Result
In the multiple-choice test, which had a maximum score of 10, Group V had a mean post-test score of 8.586 (SD 1.296), significantly higher than Group T, which had a mean score of 7.833 (SD 1.367) (p=0.034). Furthermore, when evaluating the learning outcomes within Group V, it was found that the mean post-test score four weeks later was 9.00 (SD 1.50), which was significantly higher than the pre-test mean score of 3.00 (SD 2.00) (p<0.001). Additionally, the satisfaction rating regarding the appropriateness of the learning duration in Group V was 5.00 (IQR 0), significantly higher than that of Group T, which was rated at 4.00 (IQR 2.00) (p<0.001).
Conclusion
Video-based learning on intraosseous fluid catheterization is effective and does not differ from traditional face-to-face learning.