Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy
I couldn't really tell from this if the reason better outcomes were observed was because the intervention was delivered fast enough not to trigger the neuronal cascade of death. If we don't know what that time cutoff is then we don't know what the goal should be. And all these problems could be eliminated if we followed up on research
to have a fast, easy and objective diagnosis with no neurologist
involvement.
Test out these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
http://www.ncbi.nlm.nih.gov/pubmed/25402214
Abstract
IMPORTANCE:
The
effectiveness of intravenous thrombolysis in acute ischemic stroke is
time dependent. The effects are likely to be highest if the time from
symptom onset to treatment is within 60 minutes, termed the golden hour.
OBJECTIVE:
To determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome. (Wrong objective; should be better recovery results)
DESIGN, SETTING, AND PARTICIPANTS:
The
prospective controlled Prehospital Acute Neurological Treatment and
Optimization of Medical Care in Stroke study was conducted in Berlin,
Germany, within an established infrastructure for stroke care. Weeks
were randomized according to the availability of a specialized ambulance
(stroke emergency mobile unit (STEMO) from May 1, 2011, through January
31, 2013. We included 6182 consecutive adult patients for whom a stroke
dispatch (44.1% male; mean [SD] age, 73.9 [15.0] years) or regular care
(45.0% male; mean [SD] age, 74.2 [14.9] years) were included.
INTERVENTIONS:
The
STEMO was deployed when the dispatchers suspected an acute stroke
during emergency calls. If STEMO was not available (during control
weeks, when the unit was already in operation, or during maintenance),
patients received conventional care. The STEMO is equipped with a
computed tomographic scanner plus a point-of-care laboratory and
telemedicine connection. The unit is staffed with a neurologist trained
in emergency medicine, a paramedic, and a technician. Thrombolysis was
started in STEMO if a stroke was confirmed and no contraindication was
found.
MAIN OUTCOMES AND MEASURES:
Rates of golden hour thrombolysis, 7- and 90-day mortality, secondary intracerebral hemorrhage, and discharge home.
RESULTS:
Thrombolysis
rates in ischemic stroke were 200 of 614 patients (32.6%) when STEMO
was deployed and 330 of 1497 patients (22.0%) when conventional care was
administered (P < .001). Among all patients who received
thrombolysis, the proportion of golden hour thrombolysis was 6-fold
higher after STEMO deployment (62 of 200 patients [31.0%] vs 16 of 330
[4.9%]; P < .01). Compared with patients with a longer time from
symptom onset to treatment, patients who received golden hour
thrombolysis had no higher risks for 7- or 90-day mortality (adjusted
odds ratios, 0.38 [95% CI, 0.09-1.70]; P = .21 and 0.69 [95% CI,
0.32-1.53]; P = .36) and were more likely to be discharged home
(adjusted odds ratio, 1.93 [95% CI, 1.09-3.41]; P = .02).
CONCLUSIONS AND RELEVANCE:
The
use of STEMO increases the percentage of patients receiving
thrombolysis within the golden hour. Golden hour thrombolysis entails no
risk to the patients' safety and is associated with better short-term
outcomes. (Tell us what those better results were)
TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT01382862.
No comments:
Post a Comment