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Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience [Quien está en el servicio de emergencia importa al hablar de tiempo puerta-aguja: experiencia de un centro clínico]

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dc.contributor.authorbrunser, alejandro
dc.contributor.authorNuñez; Juan
dc.contributor.authorMansilla, Eloy
dc.contributor.authorCavada, Gabriel
dc.contributor.authorOlavarría, Verónica V.
dc.contributor.authorMunoz Venturelli, Paula
dc.contributor.authorLavados, Pablo
dc.date.accessioned2024-04-30T21:04:34Z
dc.date.available2024-04-30T21:04:34Z
dc.date.issued2023
dc.description.abstractBackground: The efficacy of intravenous thrombolysis (IVT) is time-dependent. Objective: To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ≤ 20 minutes. Methods: Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021. Results: A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66–11.5, p  = 0.004). In univariate analysis DTN time ≤ 20 minutes was associated with treatment by a SN ( p  = 0.002), coronavirus disease 2019 pandemic period ( p  = 0.21), time to emergency room (ER) ( p  = 0.21), presence of diabetes ( p  = 0.142), hypercholesterolemia ( p  = 0.007), atrial fibrillation ( p  < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) ( p  = 0.001), lower systolic ( p  = 0.143) and diastolic ( p  = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p  = 0.09), vessel occlusion ( p  = 0.05), use of tenecteplase ( p  = 0.18), thrombectomy ( p  = 0.13), and years of experience of the physician ( p  < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44–10.8; p  = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02–1.12; p  < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96–0.99; p  < 0.003) remained significant. Conclusion: Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes.
dc.description.versionAceptada
dc.identifier.citationBrunser AM, Nuñez JC, Mansilla E, Cavada G, Olavarría V, Muñoz Venturelli P, Lavados PM. Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience. Arq Neuropsiquiatr. 2023 Jul;81(7):624-631. doi: 10.1055/s-0043-1768672
dc.identifier.doihttps://doi.org/10.1055/s-0043-1768672
dc.identifier.urihttps://hdl.handle.net/11447/8698
dc.language.isoen
dc.subjectStroke
dc.subjectFibrin Clot Lysis Time
dc.subjectThrombolytic Therapy
dc.titleWho is in the emergency room matters when we talk about door-to-needle time: a single-center experience [Quien está en el servicio de emergencia importa al hablar de tiempo puerta-aguja: experiencia de un centro clínico]
dc.title.alternativeQuien está en el servicio de emergencia importa al hablar de tiempo puerta-aguja:experiencia de un centro clínico
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceArquivos de neuro-psiquiatria
dspace.entity.typePublication
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relation.isAuthorOfPublication.latestForDiscovery80b7d5cb-f995-4261-af5a-e2e6d9539c21

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