Abstract
INTRODUCTION:In Stroke, the time between onset of symptoms and administration of reperfusion therapy is associated with the outcome. There is a clear benefit when patients are transported by Emergency Medical Service (EMS), and in the shortest possible time.
OBJECTIVE:To determine the time between the ambulance dispatch and the arrival of the patient to the emergency department in stroke patient ambulance transfers by the public EMS in Bogotá, during the years 2013 and 2014.
MATERIALS AND METHODS:A descriptive observational study of a historical cohort of the stroke patient ambulance transfers of the prehospital program of the Centro Regulador de Urgencias y Emergencias de Bogotá
RESULTS:2,161 transfers were included, 1,218 correspond to 2013 and 943 to 2014.
The median of time to the scene was 13 and 12 minutes (IQR 9-19 and 8-17 for 2012 and 2013 respectively), 30 minutes for the time of evaluation (IQR: 22-39 and 22-36 for the years 2013 and 2014 respectively) and 63 minutes for the total time for both years (IQR 50-79 and 49-72, for the years 2013 and 2014 respectively)
References
Giroud M, Milan C, Beuriat P, Gras P, Essayagh E, Arveux P, et al. Incidence and survival rates during a two-year period of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks. The Stroke Registry of Dijon: 1985-1989. Int J Epidemiol. 1991;20(4):892-9.
Mackay J, Mensah GA, The atlas of heart disease and stroke. Geneva: World Health Organization; 2004. Disponible en: http://www.who.int/cardiovascular_diseases/resources/atlas/en/
Aboderin I, Venables G. Stroke management in Europe. Pan European Consensus Meeting on Stroke Management. J Intern Med. 1996;240(4):173-80.
Stroke Unit Trialists' Collaboration1. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev.2013, 9, CD000197. http://dx.doi.org/10.1002/14651858. CD000197.pub3.
Saka O, Serra V, Samyshkin Y, McGuire A, Wolfe CC. Cost-Effectiveness of Stroke Unit Care Followed by Early Supported Discharge. Stroke. 2009;40(1):24-29. https://doi.org/10.1161/STROKEAHA.108.518043
Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245-51.
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274(13):1017-25.
Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282(21):2019-26.
Alberts MJ, Perry A, Dawson D V, Bertels C. Effects of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke. 1992;23(3):352-6.
Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, et al. Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med. 1999;33(1):3-8.
Culley LL, Henwood DK, Clark JJ, Eisenberg MS, Horton C. Increasing the efficiency of emergency medical services by using criteria based dispatch. Ann Emerg Med. 1994;24(5):867-72.
Kothari R, Barsan W, Brott T, Broderick J, Ashbrock S. Frequency and accuracy of prehospital diagnosis of acute stroke. Stroke. 1995:26(6).937-41.
Cabral NL, Moro C, Silva GR, Scola RH, Werneck LC. Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil. Arq Neu-ropsiquiatr. 2003;61(2A):188-93. http://dx.doi.org/10.1590/ S0004-282X2003000200006
Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929-35. http://dx.doi.org/10.1016/S0140-6736(14)60584-5
Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375(9727):1695-703. http://dx.doi.org/10.1016/S0140-6736(10)60491-6
Suyama J, Crocco T. Prehospital care of the stroke patient. Emerg Med Clin North Am. 2002;20(3):537-52.
Pepe PE, Zachariah BS, Sayre MR, Floccare D. Ensuring the chain of recovery for stroke in your community. Acad Emerg Med. 1998;5(4):352-8. http://dx.doi.org/10.1111/j.1553-2712.1998.tb02721.x
Jin H, Zhu S, Wei JW, Wang J, Liu M, Wu Y, et al. Factors associated with prehospital delays in the presentation of acute stroke in urban China. Stroke. 2012;43(2):362-70. http://dx.doi.org/10.1161/STROKEAHA.111.623512
Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001;56(8):1015-20.
Hsieh M-J, Tang S-C, Chiang W-C, Huang K-Y, Chang AM, Ko PC-I, et al. Utilization of emergency medical service increases chance of thrombolytic therapy in patients with acute ischemic stroke. J Formos Med Assoc. 2014;113(11):813-9.
Meza Bejarano Y, Rodríguez Quintana JH, Amaya González P, Restrepo HF. Contraindications for thrombolysis in patients with acute ischemic stroke. Acta Neurol Colomb. 2013;29(1):4-9.
Pérez M, Massaro M, Bareño J, Franco C. La edad y factores clínicos asociados al desenlace funcional a seis meses en pacientes con ataque cerebrovascular isquémico atendidos durante el 2011 en el Instituto Neurológico de Colombia. Acta Neurol Colomb. 2015;31(2):167-75.
Silva-Sieger F, Arenas-Borda W Zarruk-Serrano JG, Restrepo J, Bernal-Pacheco O, Ramírez S, et al. [Factors associated to the visiting time in patients with ischaemic cerebrovascular disease]. Rev Neurol. 2007;44(5):259-64. Spanish
Yperzeele L, Van Hooff R-J, De Smedt A, Valenzuela Espinoza A, Van de Casseye R, Hubloue I, et al. Prehospital stroke care: limitations of current interventions and focus on new developments. Cerebrovasc Dis. 2014;38(1):1-9. http://dx.doi.org/10.1159/000363617
Desai JA, Smith EE. Prenotification and other factors involved in rapid tPA administration. Curr Atheroscler Rep. 2013;15(7):337. http://dx.doi.org/ 10.1007/s11883-013-0337-5
Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S. Prehospital and Emergency Department Delays After Acute Stroke: The Genentech Stroke Presentation Survey. Stroke. 2000;31(11):2585-90.
Memis S, Tugrul E, Evci ED, Ergin F. Multiple causes for delay in arrival at hospital in acute stroke patients in Aydin, Turkey. BMC Neurol. 2008;8(1):15. http://dx.doi.org/10.1186/1471-2377-8-15
Park HA, Ahn KO, Shin S Do, Cha WC, Ro YS. The Effect of Emergency Medical Service Use and Inter-hospital Transfer on Prehospital Delay among Ischemic Stroke Patients: A Multi-center Observational Study. J Korean Med Sci. 2016;31(1):139-46. http://dx.doi.org/10.3346/jkms.2016.31.1.139
Doggen CJM, Zwerink M, Droste HM, Brouwers PJAM, van Houwelingen GK, van Eenennaam FL, et al. Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study. BMC Emerg Med. 2016;16(1):3. http://dx.doi.org/10.1186/s12873-015-0065-y
Minnerup J, Wersching H, Unrath M, Berger K. Effects of emergency medical service transport on acute stroke care. Eur J Neurol. 2014;21(10):1344-7. http://dx.doi.org/10.1111/ene.12367
Menendez-Ramirez S, Devia-Jaramillo G, Navarrete-Aldana N, Romero-Cepeda K, Mendez-Mantilla C, Cortes-Aguilera M. Tiempos de respuesta del sistema prehospitalario en ataque cerebral en Bogotá durante 2006, ¿estamos cerca del ideal? Presentación oral VI Congreso Nacional e Internacional de Atención Prehospitalaria. No publicado. 2007.
Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2013;44(3):870-947. http://dx.doi.org/10.1161/STR.0b013e318284056a
Evenson KR, Schroeder EB, Legare TB, Brice JH, Rosamond WD, Morris DL. A comparison of emergency medical services times for stroke and myocardial infarction. Prehosp Emerg Care. 2001;5(4):335-9.
Chang K-C. Prehospital Delay After Acute Stroke in Kaoh-siung, Taiwan. Stroke. 2004;35(3):700-4. http://dx.doi.org/10.1161/01.STR.0000117236.90827.17
O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-23. http://dx.doi.org/10.1016/S0140-6736(10)60834-3
Bae H-J, Kim D-H, Yoo N-T, Choi JH, Huh J-T, Cha J-K, et al. Prehospital notification from the emergency medical service reduces the transfer and intra-hospital processing times for acute stroke patients. J Clin Neurol. 2010;6(3):138-42. http://dx.doi.org/10.3988/jcn.2010.6.3.138
Kim SK, Lee SY, Bae HJ, Lee YS, Kim SY, Kang MJ, et al. Prehospital notification reduced the door-to-needle time for iv t-PA in acute ischaemic stroke. Eur J Neurol. 2009;16(12):1331-5. http://dx.doi.org/10.1111/j.1468-1331.2009.02762.x
Mosley I, Nicol M, Donnan G, Patrick I, Kerr F, Dewey H. The Impact of Ambulance Practice on Acute Stroke Care. Stroke. 2007;38(10):2765-70. http://dx.doi.org/10.1161/STROKEAHA.107.483446
Rajajee V, Saver J. Prehospital Care of the Acute Stroke Patient. Tech Vasc Interv Radiol. 2005;8(2):74-80. http://dx.doi.org/10.1053/j.tvir.2005.03.004
Patel MD, Rose KM, O'Brien EC, Rosamond WD. Prehospital notification by emergency medical services reduces delays in stroke evaluation: findings from the North Carolina stroke care collaborative. Stroke. 2011;42(8):2263-8. http://dx.doi.org/10.1161/STROKEAHA.110.605857
Crocco TJ, Grotta JC, Jauch EC, Kasner SE, Kothari RU, Larmon BR, et al. EMS management of acute stroke--pre-hospital triage (resource document to NAEMSP position statement). Prehosp Emerg Care. 2007;11(3):313-7. http://dx.doi.org/10.1080/10903120701347844
European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008. Cerebrovasc Dis. 2008;25(5):457-507. http://dx.doi.org/10.1159/000131083
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