Dados do Trabalho

Título

Analysis of door-to-CT and door-to-needle time in patients with suspected stroke at the Clinical Hospital of the Federal Universisty of Minas Gerais, from 2018 to 2021

Resumo

Introduction
Stroke is one of the most important causes of morbimortality around the world. Trombolysis can improve patients outcomes, but time is crucial: When the patient gets to the emergency room, a brain computed tomography (CT) must be performed in 25 minutes and the intravenous (IV) trombolysis (first-line therapy) must be iniciated no more than 4.5 hours after the symptons onset and within one hour (60min) after admission.

Objective
To evaluate the latency to perform brain CT (door-to-CT time, DTC) and to iniciate IV trombolysis (door-to-needle time, DTN) in patients with suspected stroke at the Clinical Hospital of the Federal University of Minas Gerais, and to identify possibles flaws in the management of these patients.

Methods
We analyzed medical records of patients admitted with suspected stroke, from 2018 to 2021. We also invited professionals involved in stroke care (neurologists and nurses, both in the emergency room and in the intensive care unit - ICU) to fill forms containing questions about the initial management of stroke.

Results
A total of 947 patients were selected. 63 were submitted to IV tromboloysis. The average DTC time and DTN time were 22min and 81min, 17min and 63min, 12min and 56min, 19min and 62min in 2018, 2019, 2020 e 2021, respectively.
In addition, 30 professionals answered the questions, among these, 12 neurologists and ICU physicians, 16 nurses and 2 others professionals (clincal pharmacy and radiology technician). 20% answered correctly about maximum DTC time, 46,7% about maximum DTN time and 70% about maximum time after symptoms onset to iniciate IV trombolysis. Also, 17 professionals have reported problems with high demand in the emergency room and 22 with team comunication.

Conclusion
Despite achieving the goal of performing a CT within 25min or less, the time to iniciate the IV trombolysis after patient admission had not been reached. Furthermore, the percentages of correct answers indicate the need of professionals education update and to optimize the hospital protocols in order to minimize complaints about team comunication and professionals overload.

Palavras Chave

Stroke; door-to-CT time; door-to-needle time; trombolysis; ischemic