Authors (including presenting author) :
SOO Y (1)(2), Yeung JHH (3), Li SH (4), Yeung P (5), Kitchell AKB (6), Chan KW (2), Fan S (3), Tang OL (4), Shum WC (2), Cheung NK (7), Leung T (1) (2).
Affiliation :
(1) Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong. (2) Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital. (3) Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. (4) Department of Medicine, North District Hospital. (5) Accident and Emergency Department, Alice Ho Miu Ling Nethersole Hospital. (6) Accident and Emergency Department, North District Hospital. (7) Accident and Emergency Department, Prince of Wales Hospital.
Introduction :
In acute ischaemic stroke, emergency reperfusion therapy with intravenous thrombolysis (IV TPA) and Endovascular Thrombectomy (EVT) have narrow therapeutic time windows (< 4.5 hours and 6 hours of onset respectively). Due to shortage of manpower in Hong Kong, unfortunately, more than half of the cases in Hong Kong have a door-to-treatment time much longer than 60 minutes as recommended by international guidelines.
To shorten the door-to-treatment time, NTEC has collaborated with Hong Kong Fire Services Department to implement the Pre-hospital Identification and Notification of Stroke Patients (PRE-ACT) programme since February 2019. For patients who are potentially eligible for reperfusion therapy, ambulance personnel would notify stroke team prior to patients’ arrival to the hospital, which enables swift mobilization of manpower and imaging facilities required for emergency reperfusion therapy.
Objectives :
Here we report the clinical impact of PRE-ACT programme in NTEC. This is the first cluster in Hong Kong with multiple acute hospitals providing 24-hour pre-hospital stroke notification and thrombolysis service throughout the cluster.
Methodology :
We included consecutive patients who received pre-hospital stroke assessment by ambulance personnel under PRE-ACT programme during the period from February to October 2019 in NTEC. Efficacy and safety endpoints were compared between PRE-ACT group with historical data obtained before implementation of PRE-ACT prorgramme.
Result & Outcome :
Total 456 patients with suspected stroke received pre-hospital stroke assessment by ambulance personnel. Mean age was 70.7 13.0 years, 58.8% were male. Mean National Institutes of Health Stroke Score was 12.8 10.1. Pre-hospital notification was sent to stroke team before patients’ arrival in 359 (78.7%) cases, 82% of cases were confirmed to have stroke upon discharge. The median notification-to-door time was 8 minutes. After PRE-ACT program, the number of patients who could receive reperfusion therapy increased by 34.8%, median door-to-CT time was reduced from 26 to 10 mins (p< 0.001), median door-to-needle time was reduced from 79 to 49 minutes (p< 0.001), percentage of patients with door-to-needle time < 60 minutes increased from 49.3% to 69.0% (p=0.025), mortality rate was reduced from 12.5% to 6.5 % (p=0.3101), direct discharge rate increased from 33.8% to 43.8% (p=0.001). In Hong Kong with shortage of healthcare manpower, pre-hospital stroke notification can significantly shorten the door-to-treatment time for acute ischaemic stroke, improve treatment rate and patient outcome despite a relatively short ambulance ride.
