Thrombolysis in Stroke within 30 Minutes: Results of the Acute Brain Care Intervention Study

Time is brain: benefits of intravenous thrombolysis (IVT) in ischemic stroke last for 4.5 hours but rapidly decrease as time progresses following symptom onset. The goal of the Acute Brain Care (ABC) intervention study was to reduce the door-to-needle time (DNT) to ≤30 minutes by optimizing in-hospi...

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Bibliographic Details
Published in:PloS one 2016-11, Vol.11 (11), p.e0166668-e0166668
Main Authors: Zinkstok, Sanne M, Beenen, Ludo F, Luitse, Jan S, Majoie, Charles B, Nederkoorn, Paul J, Roos, Yvo B
Format: Article
Language:English
Subjects:
Administration, Intravenous
Aged
Aged, 80 and over
Analysis
Brain
Care and treatment
Disease Management
Emergency medical care
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Hemorrhage
Humans
Intervention
Intravenous administration
Ischemia
Male
Median (statistics)
Medicine and Health Sciences
Middle Aged
Neurology
Odds Ratio
Patients
People and Places
Stroke
Stroke - drug therapy
Stroke - etiology
Stroke - mortality
Thrombolysis
Thrombolytic Therapy
Time Factors
Time-to-Treatment
Treatment Outcome
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Summary:Time is brain: benefits of intravenous thrombolysis (IVT) in ischemic stroke last for 4.5 hours but rapidly decrease as time progresses following symptom onset. The goal of the Acute Brain Care (ABC) intervention study was to reduce the door-to-needle time (DNT) to ≤30 minutes by optimizing in-hospital stroke treatment. We performed a single-centre before (pre-intervention period: 2000-2005) versus after (post-intervention period: 2006-2012) comparison in a cohort of consecutive patients treated with IVT. The intervention consisted of the implementation of a multidisciplinary stroke protocol combining simple strategies to reduce the DNT. Primary endpoint was the DNT, presented as proportion ≤30 minutes and median time. Secondary clinical endpoints were symptomatic intracranial hemorrhage (SICH), and favourable outcome defined as a modified Rankin scale (mRs) score of 0-2 at 3 months. Endpoints were additionally adjusted for baseline imbalances between the groups. In the pre-intervention period, none (0.0%) of the 100 patients (mean age 63.8 years, median National Institutes of Health Stroke Scale [NIHSS] score 14) treated with IVT had a DNT ≤30 minutes compared to 234 (62.7%) of the 373 patients (mean age 66.7 years, median NIHSS score 10) in the post-intervention period (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0166668