Comparison of the time to cerebral computed tomography and the administration of fibrinolytics in patients with acute ischemic stroke who came to the emergency room using the emergency medical system versus self-transportation
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Abstract
Background Stroke is a life-threatening emergency and the second leading cause of death among the elderly after coronary heart disease. Stroke can cause severe and lasting disability. Treatment for acute ischemic stroke patients requires thrombolysis within 3-4.5 hours. The emergency medical system (EMS) may reduce the duration of care for patients with acute ischemic stroke.
Objective To compare the durations of thrombolysis (rt-PA) and computed tomography (CT)-scan in acute ischemic stroke patients admitted through the EMS compared to patients admitted to the emergency room themselves.
Methods This study is therapeutic efficacy research and a retrospective cohort study. The data of acute ischemic stroke patients were collected from medical records in Chiangrai Prachanukroh Hospital from 1 October 2019 – 30 September 2021 and analyzed by using t-test, rank sum test, exact probability test, univariable and multivariable linear regression analysis.
Results The study included 62 patients, results revealed that 36 patients who admitted through the emergency medical system and 26 patients who admitted to the emergency room themselves. The emergency medical services can reduce the time to visit emergency physician (p=0.026) with a mean difference 2.101 minutes (95%CI, 0.251–3.952), time to thrombolysis (p=0.024) with a mean difference 15.173 minutes (95%CI, 2.016–28.329) and time to admit stroke unit/ward (p=0.008) with a mean difference 18.071 minutes (95%CI, 4.678 – 31.464).
Conclusions and Recommendations Emergency medical services can reduce the time to thrombolysis in patients with acute ischemic stroke. Therefore, the emergency medical service system should be developed in terms of healthcare providers service and public access.
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