Analyses of the Turkish National Intravenous Thrombolysis Registry

Acute stroke management in Turkey: Current situation and future projection

In Turkey, the incidence of acute stroke is increasing, obviously with the contribution of the aging population. With the publication of "Directive on Health Services to be Provided to Patients with Acute Stroke" on July 18, 2019 and its entry into force in March 2021, an important period of catching up and updating has begun in the management of acute stroke patients in our country. During this period, 57 comprehensive stroke centers and 51 primary stroke centers were certified. These units have covered approximately 85% of the country's population. In addition, around 50 interventional neurologists were trained and became the directors of many of these centers. In the following 2 years, the "inme.org.tr campaign" was launched. This campaign, aimed at increasing the public's knowledge and awareness about stroke, continued unabated during the pandemic period. Now is the time to continue the efforts to ensure homogeneous quality metrics and to develop and continuously improve the established system.

Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review

STUDY OBJECTIVE

We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED).

METHODS

A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification. Primary outcomes were identified treatment delays and causes of loss of eligibility for intravenous recombinant tissue plasminogen activator (r-tPA).

RESULTS

Of patients with acute ischemic stroke, 80.2% did not meet intravenous r-tPA eligibility; the most common cause was delayed (>4.5 hours) ED arrival after symptom onset (71.82%; n=283). Of 19.8% of subjects for whom the stroke code was activated, intravenous r-tPA was administered in only 5.3%. The average time from patients' arrival to first emergency medicine resident visit, notification of acute stroke team, presence of neurology resident, and computed tomography scan interpretation was lower for patients who met criteria of intravenous r-tPA than for those who lost eligibility for fibrinolytic therapy. The average door-to-needle time was 69 minutes (interquartile range 46 to 91 minutes).

CONCLUSION

Our ED and acute stroke team had a favorable clinical performance meeting established critical time goals of inhospital care for potentially eligible patients, but a poor clinical performance for the majority of patients who were not candidates for fibrinolytic therapy.

Impact of emergency room meetings on improvement of door-to-needle times in acute ischemic stroke patients: A single center's experience

OBJECTIVE:

One major limitation of the use of intravenous tissue plasminogen activator (IV-tPA) is the short treatment window of acute ischemic stroke (AIS). In this article, we analyze the impact of emergency room meetings on step-by-step improvement of door-to-needle times (DTN).

METHODS:

This study used prospectively recorded data of AIS patients treated with IV-tPA admitted to the Sakarya University Education and Research Hospital between January 2015 and August 2017. Time benchmarks of DTN were recorded on a case-by-case basis. Meetings were held in the emergency room if there was an increase of more than 25% in DTN of subsequent AIS patients treated with IV-tPA. Guideline-recommended stroke management methods and feedback from our previous DTN data were both considered. The goal was to improve DTN within 60 minutes for at least 50% of AIS patients.

RESULTS:

Mean DTN of 20 patients was 76.9±32.4 minutes. Nine patients experienced ≤60 minute DTN times, while two were under 30 minutes. Six meetings were conducted, with two each in 2015, 2016, and 2017. Without exception, there was a reduction in DTN after all meetings. Considering the intervals of the six meetings, the ratios of patients treated at ≤60 minutes were 0%, 0%, 60%, 66.6%, 40 and 100%, respectively.

CONCLUSION:

Meetings in the emergency room, when conducted according to certain rules, can be effective in improving DTN.