Effect of the stroke team on the success of intravenous thrombolytic therapy in emergency department

Abstract

Aim: Timely initiation of intravenous thrombolytic therapy (ITT) in ischemic stroke patients reduces long-term neurological impairment and increases the success rate of the treatment. Implementing systems where clinicians establish guideline-based multidisciplinary cooperation is also essential. This study aimed to investigate the effect of door-to-needle time (DTN) in the emergency department (ED) on the early and late clinical courses of patients in cooperation with the neurology clinic. Material and Methods: The data of the acute ischemic stroke patients who underwent ITT between April 2018 and March 2022 in the ED with inter-clinical coordination were evaluated retrospectively. DTN time, National Health Institute Stroke Scale (NIHSS) scores at admission, 24 th hour, pre-treatment, discharge, and 3 rd month modified Rankin Scale scores (mRS) of the patients were recorded by the ED physician and neurologist and evaluated statistically. Results: Of the 102 patients included in the study, 51 were male, and 51 were female. The median age was 75. Of the patients, 45.1% underwent mechanical thrombectomy. The median admission and 24-hour NIHSS scores were 11 and 8, respectively. The median door-to-CT and DTN times were 18.5 minutes and 85.5 minutes, respectively. Patients with DTN times > 60 minutes had higher admission systolic and diastolic blood pressure levels than patients with DTN times < 60 minutes (p < 0.01 and p = 0.015, respectively). Good functional outcome rates (mRS score 0-2) at discharge and at 3 months were 39.2% and 49.0%, respectively. Discussion: This study showed that applying ITT with inter-clinical coordination to stroke patients in the ED is associated with a good early clinical outcome.