Radio frequency identification technology reduce intravenous thrombolysis time in acute ischemic stroke.
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ABSTRACT: Purpose
To inspect whether time management with radio frequency identification technology (RFID) reduces symptom onset-to-intravenous thrombolysis time (OTT) in acute ischemic stroke (AIS).Methods
In the retrospective study, patients with AIS, transferred by Emergency Medical Services (EMS) to Hunan Provincial People's Hospital between September 2019 to June 2022, divided into three groups, as traditional group, in-hospital RFID group and whole process RFID group. Baseline characteristics and time metrics were compared.Results
After the whole emergency process applied with RFID time management, Door to intravenous thrombolysis time (DNT) was reduced from 125.00±43.16 min to 32.59±25.45 min (F = 121.857, p<0.001), and OTT was reduced from 235.53±57.27 min to 144.31±47.96 min (F = 10.377, p<0.001).Conclusions
Time management with RFID is effective in reducing OTT in AIS patients with thrombolysis treatment.
SUBMITTER: Zhang Y
PROVIDER: S-EPMC10355394 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
Publications
Radio frequency identification technology reduce intravenous thrombolysis time in acute ischemic stroke.
Zhang Yixiong Y Jing Yingxia Y Zhu Yimin Y Jiang Tao T Tang Xianyi X Yi Weichen W
PloS one 20230719 7
<h4>Purpose</h4>To inspect whether time management with radio frequency identification technology (RFID) reduces symptom onset-to-intravenous thrombolysis time (OTT) in acute ischemic stroke (AIS).<h4>Methods</h4>In the retrospective study, patients with AIS, transferred by Emergency Medical Services (EMS) to Hunan Provincial People's Hospital between September 2019 to June 2022, divided into three groups, as traditional group, in-hospital RFID group and whole process RFID group. Baseline charac ...[more]
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Project description:ImportanceIntravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT facilities, and most patients need to be transferred secondarily after IVT (drip and ship), which may have an effect on the neurologic outcome.ObjectiveTo compare the functional independence at 3 months between patients treated under the drip-and-ship paradigm and those treated on site (mothership).Design, setting, and participantsThis study used a prospectively gathered registry of patients with AIS to select patients admitted through the Saint-Antoine and Tenon (drip and ship) or the Fondation Rothschild (mothership) hospitals from January 1, 2013, through April 30, 2016. The study included patients older than 18 years treated with bridging therapy for AIS with LVO of the anterior circulation. Among the 159 patients who received MT at the mothership, 100 had been transferred after IVT from the drip-and-ship hospitals and 59 had received IVT on site.Main outcomes and measuresThe main outcome was 3-month functional independence (modified Rankin scale score ≤2). Both groups were compared using a multivariate linear model, including variables that were significantly different in the 2 groups.ResultsDuring the study period, 497 patients were hospitalized at the drip-and-ship and mothership hospitals for an AIS eligible to reperfusion therapy; 11 patients had a basilar artery occlusion and were excluded, leaving 100 patients in the drip-and-ship group (mean age, 73 years; age range, 60-81 years; 57 men [57.0%]) and 59 in the mothership group (mean age, 70 years; age range, 58-82 years; 29 men [49.2%]). The proportion of patients with a favorable neurologic outcome at 3 months was similar in both groups (drip and ship, 61 [61.0%]; mothership, 30 [50.8%]; P = .26), even after adjusting the analysis for the baseline National Institutes of Health Stroke Scale score, diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, and general anesthesia (P = .82). Patients had less severe conditions in the drip-and-ship group (median baseline National Institutes of Health Stroke Scale score, 15 vs 17 [P = .03]; median diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, 7.5 vs 7 [P = .05]). Process times were longer in the drip-and-ship group (onset-to-needle time, 150 vs 135 minutes; onset-to-puncture time, 248 vs 189 minutes; and onset-to-recanalization time, 297 vs 240 minutes; P < .001). Both groups were similar in terms of substantial recanalization (Thrombolysis in Cerebral Ischemia scores 2B to 3; drip and ship, 84 [84.0%]; mothership, 47 [79.7%]; P = .49) and symptomatic hemorrhagic transformation (drip and ship, 2 [2.0%]; mothership, 2 [3.4%]; P = .63).Conclusions and relevanceThis study found that patients treated under the drip-and-ship paradigm also benefit from bridging therapy, with no statistically significant difference compared with those treated directly in a comprehensive stroke center.
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Project description:ImportanceStroke is a major cause of morbidity and mortality. Timely administration of intravenous thrombolysis (IVT) is essential for improving outcomes for patients with acute ischemic stroke. Significant disparities exist in IVT administration based on socioeconomic and racial and ethnic backgrounds. Understanding how hospital-level segregation is associated with stroke treatment outcomes is crucial for addressing these disparities.ObjectiveTo investigate the association between hospital segregation, using the Index of Concentration at the Extremes (ICE), and IVT administration rates among patients with stroke.Design, setting, and participantsThis retrospective cohort study used US hospital data from the 2016-2020 National Inpatient Sample database. Using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes, patients admitted to hospitals with acute ischemic stroke were included. Statistical analysis was performed from March through July 2024.ExposureHospital segregation measured by the ICE, quantifying socioeconomic and racial and ethnic extremes within hospitals. ICE values range from -1 (predominantly Black and socioeconomically disadvantaged) to 1 (predominantly White and socioeconomically advantaged). Hospitals were categorized into ICE quintiles, with the first quintile representing the most disadvantaged hospitals, the third quintile representing a balanced patient mix, and the fifth quintile representing the most privileged hospitals.Main outcomes and measuresThe primary outcome was IVT administration rates. Secondary outcomes included racial and ethnic disparities in IVT administration across ICE quintiles.ResultsAmong 2 494 945 patients with stroke, the mean (SD) age was 70.1 (14.0) years, 50.2% were male, 0.5% were American Indian, 3.1% were Asian or Pacific Islander, 17.4% were Black, 8.2% were Hispanic, 68.2% were White, and 2.6% were other race or ethnicity. Of these patients, 65.4% were treated at hospitals in the third ICE quintile, while 1.2% of patients were treated at hospitals in the first ICE quintile. Patients at hospitals in the fourth and fifth ICE quintiles were significantly more likely to receive IVT (fourth quintile: adjusted odds ratio [AOR], 1.32 [95% CI, 1.26-1.38]; fifth quintile: AOR, 1.27 [95% CI, 1.21-1.34]) compared with those in the first quintile. Racial and ethnic disparities in IVT administration were most pronounced in the first ICE quintile, where Black patients were 32% less likely than White patients to receive IVT (AOR, 0.68 [95% CI, 0.58-0.79]). This disparity decreased but persisted in higher quintiles.Conclusions and relevanceIn this study of hospital segregation and IVT administration rates, segregation was associated with lower likelihood of IVT administration for patients at hospitals serving predominantly Black and socioeconomically disadvantaged communities. Socioeconomic improvements were associated with reduced, but not eliminated, racial and ethnic disparities in stroke treatment. Addressing structural racism and segregation is crucial for equitable access to stroke care.
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Project description:Approximately 20% of the US population primarily speaks a language other than English at home. Yet the effect of language preference on treatment of acute ischemic stroke (AIS) patients remains unknown. We aimed to evaluate the influence of language preference on AIS patients' receipt of intravenous (IV) thrombolysis. We analyzed data from 3894 AIS patients who participated in the American Heart Association "Get With The Guidelines®-Stroke" program at our hospital from January 1, 2003 to April 30, 2014. Information included patients' language in which they preferred to receive medical care. We used descriptive statistics and stepwise logistic regression models to examine associations between patients' language preference and receipt of IV thrombolysis, adjusting for relevant covariates. A total of 306/3295 (9.3%) AIS patients preferred to speak a non-English language and represented 25 different languages. Multivariable analyses adjusting for other socioeconomic factors showed that non-English-preferring patients were more likely than English-preferring patients to receive IV thrombolysis (OR=1.64; CI=1.09-2.48; P=0.02). However, in models that also included age, sex, and initial NIH Stroke Scale, patients' language preference was no longer significant (OR 1.38; CI=0.88-2.15; P=0.16), but NIH Stroke Scale was strongly associated with receiving IV thrombolysis (OR=1.15 per point; CI=1.13-1.16; P<0.0001). Contrary to our hypothesis, non-English-preferring was not associated with lower rates of IV thrombolysis among AIS patients once initial stroke severity was accounted for.
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