Abstract
Introduction: The Acute Ischemic Stroke (AIS) is pathology with an approximate prevalence of 500-600 per 100,000 people in white population and a rate to 5.54 million deaths annually. The thrombolytic therapy within 4.5 hours improvement the ACV long-term prognosis. The use of clinical pathways has demonstrated reduce the attention time in pathologies with specific treatment like ACV.
Objective: To determine the effect of implementing the pathway for patients' care with hyperacute ischemic stroke in reducing door-to-imaging time.
Materials and methods: Study before and after implementation of the pathway for patients' care with hyperacute ischemic stroke who were admitted to the emergency department. Demographic variables and time intervals of door-to-imaging time, door to neurology evaluation and door-to- needle-time were measured.
Results: The mean age was 68.8 years (SD13) before and 70 years (SD 12) after. The median (IQR) door-to-imaging time was 33 (18.5-54) minutes before and 6,5 (-9-30) after p: 0,017. The median (IQR) door to - neurology evaluation was 90 (16-116) before and 38 (11.5-110) after. The median (IQR) door-to thrombolysis time was 74 (53-119) before and 86 (45-100) after. The percentage of patients undergoing thrombolytic therapy was similar.
Conclusion: The implementing the pathway for patients' care with hyperacute ischemic stroke in reduces door-to-imaging time.
References
SALUD ONMDL. Estadísticas sanitarias mundiales. Recuperado de http://www.who.int2014.
SILVA FA, QUINTERO C, ARENAS W, RUEDA-CLAUSEN CF, SILVA S, ET AL. Enfermedad cerebrovascular en Colombia. Rev Col Cardiol. [revista en Internet] 2006 Oct [citado 2012 Ago 11]; 13(2):85-9.
PRADILLA GV, LEÓN-SARMIENTO FE. Estudio neuroepidemiológico nacional (Epineuro) colombiano. Rev Panam Salud Pública [serial en Internet] 2003;2:104-11.
Organization. WH. NEUROLOGICAL DISORDERS public health challenges. Julien Bogousslavsky (chair) ML, J. Moncayo, B. Norrving, A. Tsiskaridze,, T. Yamaguchi FY, editor. WHO publications. Geneva, Switzerland. 2006.
THE NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE RT-PA STROKE STUDY GROUP. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7.
HACKE W, KASTE M, BLUHMKI E, BROZMAN M, DÁVALOS A, GUIDETTI D, ET AL. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29.
SAVER JL. Time is brain-quantified. Stroke 2006;37(1):263-6.
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.
ADAMS HP, JR., DEL ZOPPO G, ALBERTS MJ, BHATT DL, BRASS L, FURLAN A, ET AL. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 38. United States 2007: 1655-711.
JAUCH EC, SAVER JL, ADAMS HP, JR., BRUNO A, CONNORS JJ, 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.
RENHOLM M, LEINO-KILPI H, SUOMINEN T. Critical pathways. A systematic review. J Nurs Adm. 2002;32(4):196-202.
ALBERTS MJ, LATCHAW RE, JAGODA A, WECHSLER LR, CROCCO T, GEORGE MG, ET AL. Revised and updated recommendations for the establishment of primary stroke centers: a Summary statement from the brain attack coalition. Stroke 2011;42(9):2651-65.
KWAN J, SANDERCOCK P. In-hospital care pathways for stroke: a Cochrane systematic review. Stroke 2003;34(2):587-8.
SUZUKI M, IMAI A, HONDA M, KOBAYASHI K, OHTSUKA S. Role of a critical pathway for door-to-CT-completion interval in the management of acute ischemic stroke patients in the emergency room. Keio J Med. 2004;53(4):247-50.
ROSE KM, ROSAMOND WD, HUSTON SL, MURPHY CV, TEGELER CH. Predictors of time from hospital arrival to initial brain-imaging among suspected stroke patients: the North Carolina Collaborative Stroke Registry. Stroke. 2008;39(12):3262-7.
FONAROW GC, SMITH EE, SAVER JL, REEVES MJ, BHATT DL, GRAU-SEPÚLVEDA MV, ET AL. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011;123(7):750-8.
SAUSER K, LEVINE DA, NICKLES AV, REEVES MJ. Hospital Variation in Thrombolysis Times Among Patients With Acute Ischemic Stroke: The Contributions of Door-to-Imaging Time and Imaging-to-Needle Time. JAMA Neurol. doi:10.1001/jamaneurol.2014.1528.
FONAROW GC, ZHAO X, SMITH EE, SAVER JL, REEVES MJ, BHATT DL, ET AL. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014;311(16):1632-40.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
