Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians Iiro Heikkilä, MD, Hanna Kuusisto, MD, PhD, Markus Holmberg, MD, Ari Palomäki,

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Presentation transcript:

Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians Iiro Heikkilä, MD, Hanna Kuusisto, MD, PhD, Markus Holmberg, MD, Ari Palomäki, MD, PhD Annals of Emergency Medicine Volume 73, Issue 2, Pages 105-112 (February 2019) DOI: 10.1016/j.annemergmed.2018.07.019 Copyright © 2018 American College of Emergency Physicians Terms and Conditions

Figure 1 The trial profile was a before-after intervention analysis. Group 1 (ie, “before”) represents 2009 to 2012; and group 2, 1 year (from October 1, 2013, until September 30, 2014). Annals of Emergency Medicine 2019 73, 105-112DOI: (10.1016/j.annemergmed.2018.07.019) Copyright © 2018 American College of Emergency Physicians Terms and Conditions

Figure 2 A, Before the reorganization (group 1, 2009 to 2012), in median DNTs there were no trends either to decrease or increase (NS). B, In group 1 (ie, “before,” 2009 to 2012), median DNT was 54 minutes. After reorganization, it was 20 minutes (group 2 [ie, “after,” 12 months from October 1, 2013]). The difference (statistical estimate 32 minutes; 95% CI 26 to 38 minutes) was significant. DNT as in A. Also shown is a back-to-back histogram representing same results. Box plots represent medians and interquartile range. Whiskers and outliers (open circles) represent the whole range of DNTs. In group 1, minimum and maximum DNTs were 20 minutes and 2 hours, 11 minutes, respectively. In group 2, they were 8 and 60 minutes, respectively. Annals of Emergency Medicine 2019 73, 105-112DOI: (10.1016/j.annemergmed.2018.07.019) Copyright © 2018 American College of Emergency Physicians Terms and Conditions

Figure 3 Median OTT was 135 minutes before reorganization (group 1). After implementation of the new stroke protocol, it was 119 minutes (group 2). The difference (statistical estimate 23 minutes; 95% CI 6 to 39 minutes) was significant (P=.006). Annals of Emergency Medicine 2019 73, 105-112DOI: (10.1016/j.annemergmed.2018.07.019) Copyright © 2018 American College of Emergency Physicians Terms and Conditions

Figure 4 Main prerequisites and elements of the intervention. Modified from our earlier publication.7 INR, International normalized ratio. Annals of Emergency Medicine 2019 73, 105-112DOI: (10.1016/j.annemergmed.2018.07.019) Copyright © 2018 American College of Emergency Physicians Terms and Conditions