| Objective: The purpose of this study is to investigate the in-hospital diagnosis and treatment time for patients with acute ischemic stroke in Hebei Province,which provides the theoretical basis for further optimizing the treatment process of acute ischemic stroke and shortening the duration of treatment time in the future.Methods: We collected the diagnosis and treatment data of patients with acute ischemic stroke,which come from 49 hospitals from Hebei Province,admission to the emergency department between January 2016 and December 2016.The in-hospital diagnosis and treatment time was divided into three key steps: emergency admission to completing the cranial CT scan,completing the CT scan to getting the CT report,getting the CT report to initial treatment.Getting the CT report to initial treatment was subdivided into three time periods: getting the CT report to informing the risk,informing the risk to obtaining patient consent,obtaining patient’s consent to initial treatment.We compare the time of each key step to recommended time by NINDS between hospitals of different grades.Results: A total of 1823 acute ischemic stroke patients were collected,among them 1365 patients from Tertiary Hospital and 458 patients from Secondary Hospital.Of these,1161 patients were males(63.69%)and 662 patients were females(36.31%).The mean age of patients was 71.67±18.93 years old and the age range was 20 to 98 years old.405 cases(22.22%)were admitted to the hospital by ambulance,nevertheless 1418(77.78%)patients by others.The median time consumed in diagnosis and treatment in hospital was 104 minutes(interquartile range,85-125 minutes),which had significant differences compared to the NINDS recommended 25-minute(P=0.09).Of these,the ratio of door to needle time over 60 min was 91.17%.The time consumed in emergency admission to completing the cranial CT scan was 25 minutes(interquartile range,17-38 minutes)and had significant difference in contrast to the NINDS recommended 25-minute(P<0.001).The median time from completing the cranial CT scan to getting the CT report of 30 minutes(interquartile range,23-40 minutes)and differed significantly to the recommended 20 minutes by NINDS(P<0.001);The median time from getting the CT report to obtaining treatment of 43 minutes(interquartile range,27-59 minutes)and the recommended time was 15 minutes by NINDS,there was significant statistical differences(P<0.001).The period from getting the CT report to initial treatment was divided into three time periods,of which the median time of getting the CT report to informing the risk was 9 minutes(interquartile range,5-11 minutes).The median time of informing the risk to obtaining patient consent was 18 minutes(interquartile range,10-37 minutes).The median time of obtaining patient consent to initial treatment was 7 minutes(interquartile range,5-12 minutes).The patients who choose Emergency service as the delivery method consumed 101 minutes(interquartile range,83-120 minutes)and those who did not consumed 104 minutes(interquartile range,86-126 minutes)(P=0.01).In Tertiary Hospital the in-hospital median delay time was 105 minutes was longer than 99 minutes in Secondary Hospital and there have statistical difference(P<0.05).Conclusion: The in-hospital emergency treatment delay in Hebei Province was relatively serious for patients with acute ischemic stroke.Except the emergency admission to completing the cranial CT scan period,the other two time periods of diagnosis and treatment for acute ischemic stroke were all delay when compared with the recommend time by the NINDS.The time consumed in the CT diagnosis to initial treatment was the most large proportion time consumed in diagnosis and treatment procedure in hospital.The use of emergency service system can shorten in-hospital delay for acute ischemic stroke.There were differences in-hospital delay between hospitals of different levels.Compared with tertiary hospital,the secondary hospital had shorter in-hospital delay time. |
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