Impact of an intrahospital mobile thrombolysis team on 3-month clinical outcomes in patients benefiting from intravenous thrombolysis for acute ischemic stroke.
OBJECTIVE
The benefits of thrombolysis in patients presenting with acute ischemic stroke (IS) are highly time-dependent. The aim of our study was to evaluate the clinical benefit, after 3 months, of an intrahospital mobile thrombolysis team (MTT) for thrombolysis in IS.


METHODS
A total of 95 consecutive patients treated with IV tPA for acute IS at the neurology department of Rouen University Hospital between 1 January and 31 December 2015 were retrospectively identified. Patients who had benefited from mechanical thrombectomy or hemicraniectomy were excluded. The study compared 33 patients who had benefited from our MTT (thrombolysis whatever the location and as soon as possible by a specific nurse) with 62 patients treated in the usual way (thrombolysis only at the stroke unit). Management timescales, inhospital and 3-month clinical outcomes, and imaging data were also compared between the two groups.


RESULTS
Demographic data and factors known to influence the clinical course after thrombolysis were similar between the two groups (P>0.05). However, use of the MTT allowed significant decreases in the median onset-to-treatment (OTT) time of 26min and median door-to-needle (DTN) time of 27min (P<0.001). The proportion of patients with a DTN time<60min was higher in the MTT group than in the usual care (UC) group: 64% vs. 14%, respectively (P<0.001), according to American Heart Association/American Stroke Association guidelines. Although there was a smaller proportion of negative 3-month outcomes (modified Rankin Scale score: 6; 6% vs. 16%) and a larger proportion of highly favorable 3-month outcomes (mRS score: 0-1; 79% vs. 64%) in the MTT vs. UC groups, respectively, these differences were not statistically significant (P>0.05).


CONCLUSIONS
Use of an MTT is a simple way to reduce thrombolysis delays, and the present results encourage us to improve the system to make it even more effective and available for all patients.
Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
B
B
Hebant
Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
A
A
Triquenot-Bagan
Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
E
E
Guegan-Massardier
Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
O
O
Ozkul-Wermester
Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
L
L
Grangeon
Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France; INSERM U1073, Rouen Faculty of Medicine, 22 Boulevard Gambetta, 76000 Rouen, France. Electronic address: David.Maltete@chu-rouen.fr.
D
D
Maltête
D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents
Door-to-needle time; Management timescales; Onset-to-treatment time; Stroke; Thrombolysis