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Master Thesis

Impact of direct admission in neuroimaging room to reduce door-to-needle time in acute ischemic stroke: a comprehensive stroke center experience

Abstract : Introduction: Early management of patients with acute ischemic stroke (AIS) remains crucial. Efficacy of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) is strongly time dependent. Door-to-needle time (DTN) is a powerful marker of in-hospital delays, with a benchmark ≤ 60 minutes currently recommended. Method: We studied the impact of direct magnetic resonance imaging (MRI) room admission initiated in September 2017, for patient treated by IVT and/or MT. We compared a group “Direct MRI room admission” to patients admitted in emergency medical department or other (group “Emergency department admission”). Primary endpoint was the proportion of patients with DTN ≤ 60 minutes. Constituents of DTN, clinical and functional outcomes were also analyzed using National Institute of Health Stroke Scale (NIHSS), and modified Rankin scale. Results: Among 308 patients, 62 underwent direct MRI room admission. Proportion of patients with DTN ≤ 60 minutes was higher in the “Direct MRI room admission” group compared to the “Emergency department admission” group (82.5% vs 17.8%) and median DTN was lower (45min vs 75min). Moreover, we found a better decrease of clinical deficit (NIHSS decrease between initial examination to one day after treatment: 48.1% vs 22.3%). Despite a functional benefit at discharge (mRS [0-2, as independence]: 66,1% vs 51,2%), no difference was found at 6 months (68,4% vs 57,4%). Discussion: The direct admission in neuroimaging room of stroke alerts is associated with an important decrease of delay for IVT and MT, and a functional benefit one day after treatment and at discharge. Larger studies are warranted to assess long term effect of this strategy.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03041019
Contributor : Jean-Hugues Morneau <>
Submitted on : Friday, December 4, 2020 - 4:31:42 PM
Last modification on : Wednesday, December 9, 2020 - 3:24:30 AM
Long-term archiving on: : Friday, March 5, 2021 - 7:24:21 PM

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Loïc Legris. Impact of direct admission in neuroimaging room to reduce door-to-needle time in acute ischemic stroke: a comprehensive stroke center experience. Human health and pathology. 2020. ⟨dumas-03041019⟩

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