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Clin Neurol Neurosurg ; 115(9): 1583-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23489443

RESUMO

OBJECTIVES: Narrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study. PATIENTS AND METHODS: Intrahospital processing times and t-PA treatment were analyzed in stroke patients calling within 6h and admitted in our stoke unit. Patients transferred by our mobile medical team (SAMU) and by Fire Department (FD) paramedics were compared. RESULTS: 193 (61.6%) SAMU patients and 120 (38.4%) FD patients were included within 30 months. Clinical characteristics and onset-to-call intervals were similar in the two groups. Mean door-to-imaging delay was deeply reduced in the SAMU group (52 vs. 159 min, p<0.0001) and was <25 min in 50% of SAMU patients and 14% of FD patients (p<0.0001). SAMU management was the only independent factor of early imaging (p=0.0006). t-PA administration rate was higher in SAMU group than in FD group (42% vs. 28%, p=0.04). Proportion of patients with delayed therapeutic window was higher in FD group than in SAMU group (38% vs. 26%, p<0.0001). CONCLUSION: Prehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke.


Assuntos
Serviços Médicos de Emergência/métodos , Medicalização , Transferência de Pacientes/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Idoso , Ambulâncias , Feminino , Fibrinolíticos/uso terapêutico , França , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde , Equipe de Assistência ao Paciente , Médicos , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Ativador de Plasminogênio Tecidual/uso terapêutico
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