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Intrahospital tidsbruk ved intravenøs trombolyse ved hjerteinfarkt. Hva er årsakene til forsinket behandling?

Authors: Schippert, Hans Fredrik Soares;

Intrahospital tidsbruk ved intravenøs trombolyse ved hjerteinfarkt. Hva er årsakene til forsinket behandling?

Abstract

BACKGROUND: On the subject of cerebral infarction, it is a common saying that “time is brain”. The prognosis of a patient who has received thrombolysis after such an infarction becomes significantly better as the time from symptom debut until the thrombolytic bolus lessens. Identifying the factors that contribute to longer times before thrombolysis for patients could thus be meaningful, and this is exactly what the aim of this assignment is. METHODS: Data was collected from the digital documents of patients who had received thrombolytic treatment from Akershus University Hospital. Both linear and categorical variables were registered from fields such as the patients’ background, vitals and disease severity. Time from onset to arrival at the hospital and time from arrival to the start of the infusion were registered in detail, and potentially delaying factors such as uncertain time of symptom debut and suspected contraindications were explored. The official Norwegian limit for delayed thrombolysis is 40 minutes, and thus this was chosen as the limit in this assignment as well. RESULTS: A total of 100 patients were registered, having received thrombolysis in 2015 and 2016. 50 men and 50 women were registered, with a mean age of 67.6. The mean NIHSS on arrival was 7.63 (standard variance 6.06). The mean time from symptom debut until arrival was 90.09 min (standard variance 48.91) and the mean time from arrival until the thrombolysis was given was 46.24 min (standard variance 33.40). 48.0% of the patients received thrombolysis more than 40 min after arrival, thus defining it as delayed treatment. The factors which showed a significant association with delayed treatment, using a confidence interval of 95%, were smoking (p=0.028), necessary prethrombolytic reduction in blood pressure (p=0.002), suspected contraindication (p=0.023) and uncertain severity of disease (p=0.001). Factors that unexpectedly showed no significant association with delayed treatment were uncertain time of symptom debut and high NIHSS on arrival. CONCLUSION: Factors that may have contributed to delayed thrombolysis were smoking, prethrombolytic reduction of blood pressure, suspected contraindications and uncertain severity of disease. In order to shorten the time from arrival to treatment, the effects of these factors on the efficiency of the thrombolytic procedure must be minimized. This could be attempted by using tools such as stricter, clearer guidelines and hospital campaigns targeting the attitudes of the personnel. All this being said, this assignment has made it clear that the treatment of cerebral infarctions is largely successful.

Keywords

thrombolysis, delay, neurology, forsinkelse, organization, cerebral infarction, stroke, hjerneinfarkt, hjerneslag, nevrologi, sykehus, hospital, tidsbruk, trombolyse, organisering

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