Network Mapping of Time to Antithrombotic Therapy Among Patients With Ischemic Stroke and Transient Ischemic Attack (TIA)

Systematic review and meta-analysis of audits measuring antithrombotic therapy within forty-eight hours for ischemic stroke

BACKGROUND

Meta-analysis of clinical trials supports the use of early antithrombotic medication in ischemic stroke and transient ischemic attack. It is not known whether this therapy is delivered within the 85 % threshold that is acceptable in North America's Get With The Guidelines stroke program.

AIM

to investigate the pooled proportion of patients receiving antiplatelet therapy within 48 h of ischemic stroke.

METHODS

PubMed to November 2022 was searched for studies reporting "stroke", "audit", "antithrombotic", "national" and "registry". Multilevel random effects meta-analysis was used to cluster studies by country.

RESULTS

There were 45 studies describing 1,178,595 patients. The pooled proportion of patients receiving antithrombotic therapy within 48 h was 81.1 %, (95 % CI 74.5, 87.8, p < 0.0001, I2=99.99 %). The high heterogeneity was due to within-country (I2Level 3 = 55.4 %) and between-country heterogeneity (I2Level 2 = 44.6 %). There was no statistical significance (p = 0.35) between low- to middle- income countries (LMIC) - 81.8 %, (95 % CI 76.1, 87.4, p < 0.01, I2=100 %) and high-income countries (HIC) - 86.8 %, (95 % CI 81.2, 92.3, p < 0.01, I2=99.7 %) nor any difference between contemporary studies (2008 and later) - 86.5 %, (95 % CI 82.3, 90.8, p < 0.01, I2=100 %) - and studies published before 2008 - 69.9 %, (95 % CI 57.4, 82.4, p < 0.01, I2=99.7 %). Sensitivity analysis showed no difference when excluding single centre studies, observations with n < 500, or both. Meta-regression showed proportion of antiplatelet administration at 48 h to increase significantly with subsequent year of publication (β=0.01, 95 % CI 0.00, 0.02, p < 0.05).

CONCLUSION

Our key finding is that the majority of countries do not yet provide early antiplatelet therapy at a level acceptable by Get With The Guidelines hospitals.

Optimization of Radiology Diagnostic Services for Patients with Stroke in Multidisciplinary Hospitals

Background

Effective radiology diagnostic services are crucial for the timely and precise diagnosis and treatment of stroke, a medical emergency, in multidisciplinary hospitals. However, the efficiency of these services might be impeded by various logistical and operational challenges present in a multidisciplinary hospital setup.

Objective

This review endeavours to explore the ways for optimizing stroke management in multi-disciplinary hospitals, delving into its benefits, current challenges, and future prospects.

Methods

Electronic databases, namely PubMed, Scopus, and Web of Science, were utilized for this review. Studies that focus on the organizational and functional aspects of radiology diagnostic services in multidisciplinary hospitals for stroke patients were analysed.

Results

This review delves into a variety of strategies that could be harnessed to enhance radiology diagnostic services, thereby better-serving stroke patients in multidisciplinary hospital settings. It sheds light on the current hurdles in the optimization of stroke management, discussing them in detail. This article also explores the application and significance of Process Mapping in streamlining workflow for stroke management in hospitals, providing insights into its benefits, challenges, and future implications. Furthermore, the potential of Artificial Intelligence (AI) and Machine Learning (ML) in refining stroke management processes is also analysed and discussed.

Conclusion

The quest for optimizing the organization of radiology diagnostic services in multidisciplinary hospitals unveils a multi-pronged pathway. It beckons a harmonious blend of technological innovation, operational finesse, and multidisciplinary camaraderie. stepwise implementation of the identified optimization strategies, coupled with a continual assessment of their impact on patient care and operational efficiency, is recommended.