Increasing Intravenous Recombinant Tissue Plasminogen Activator Administration Rate through Stroke System Management in Phanatnikhom Hospital, Chonburi Province
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Abstract
BACKGROUND: Stroke is the major cause of death and disability worldwide. Even though intravenous tissue plasminogen activator (rt-PA) is the main treatment to improve outcomes in acute ischemic stroke, the rate of administration is still low. Network and system management can increase the thrombolytic treatment rate.
OBJECTIVES: This study aimed to assess the achievement of thrombolytic administration rate and clinical outcomes after stroke system management.
METHODS: This retrospective cohort study aimed to evaluate the administration rate of intravenous tissue plasminogen activator after stroke system management. The study group was ischemic stroke patients aged 18 years or over from November 2021 to December 2022. The study aimed to determine the early arrival rate and rt-PA administration rate. Statistical analysis was used to determine the significance of related factors. The clinical outcome of treatment was evaluated for mortality and other interesting results.
RESULTS: Three hundred ischemic stroke patients were enrolled in the study; 180 (60%) of them arrived at the hospital within 4.5 hours of the event. Female gender, higher education, EMS arrival, weakness, and no alcohol/tobacco were associated with the early arrivals. In the early arrival, 38 of 180 (21%) received intravenous tissue plasminogen activator. The average door-to-needle time was 48.4 minutes (range 20-108). Thirty-five patients died (30-day mortality 11.7%). Factors related to mortality were age, comorbidity, coronary disease, atrial fibrillation, low Glasgow Coma Scale, High National Institute of Health Stroke Scale: NIHSS, Large vessel stroke, and cardio-embolic stroke.
CONCLUSION: Stroke system management as a public health network can be improved by developing the early arrival rate to 60%, increasing the rt-PA administration rate to 21%, and a short door-to-needle time of 20 minutes
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