Comparison between fibrinolyzed stroke that arrived with the emergency service or other means

Aim

Analyze the relationship between attendance times and health outcomes of people with ischemic stroke treated with intravenous fibrinolysis, comparing those attended from the emergency units of 061 ARAGON with those arriving by other means.

Method

Cross-sectional, retrospective, descriptive and association study based on a consecutive series of patients treated at the Miguel Servet University Hospital in the period 2014−16, analysing the time of care up to fibrinolysis and results of intravenous fibrinolysis, in terms of mortality and functional status at discharge. We also analysed the influence on attendance times of the protocol change that was carried out in 2016 and that included the direct warning to neurologists, instead of the receiving emergency, as before.

Results

A total of 231 patients with stroke were collected and treated with intravenous fibrinolysis. The mean age of the patients was 75.91 (±12.48). Women accounted for 52.8% of those fibrinolysed, the average age of men being lower [74.07 (±13.71) years, compared with 77.55 (±11.07) years for women]. The mean score on the NIHS scale at admission between the two groups presented significant differences (p = 0.006), being greater the affectation among those who arrived with 061 [NIHSS 13.20 ± 6.78 vs 10.7 ± 6.22]. In the comparison of times between patients who arrive or not with 061, the average time to hospital was 91.42 (±59.64) vs 93.20 (±83.73) (p = 0.731), without significant differences. However, there were significant differences in the time door needle (p = 0.046), noting that patients who are brought by 061 Aragon have better in-hospital time until fibrinolysis (better door-needle time) (67.19 (±26.03) vs 77.83 (±38.35).

In the analysis of the door needle time by years, significant differences were observed (p < 0.001), being shorter each year, with a clear shortening in 2016 compared to previous ones, reflecting the impact of the update of protocols in this time period.

Conclusions

The patients brought in by 061 were different (more affected), fibrinolysed in a greater percentage and faster. Direct notice to neurologists significantly shortened attendance times. In terms of mortality and functional status at discharge, there were no differences between the two groups.