- 作者：Eric E. Adelman ; MD* ; eriadelm@med.umich.edu" class="auth_mail" title="E-mail the corresponding author ; Phillip A. Scott ; MD&dagger ; ; Lesli E. Skolarus ; MD* ; Allison K. Fox ; MS&dagger ; ; Shirley M. Frederiksen ; MS&dagger ; ; William J. Meurer ; MD&dagger ;
- 关键词：Stroke ; thrombolysis ; emergency department ; tPA
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：2016
- 出版时间：January 2016
- 年：2016
- 卷：25
- 期：1
- 页码：67-73
- 全文大小：112 K
Methods
We used data from the Increasing Stroke Treatment through Interventional Behavior Change Tactics trial, a cluster-randomized, controlled trial evaluating the efficacy of a barrier assessment and educational intervention to increase appropriate tPA use in 24 Michigan community hospitals, to review tPA treatments between 2007 and 2010. Protocol violations were defined as deviations from the standard tPA protocol, both before and after treatment. Multilevel logistic regression models were fitted to determine if patient and hospital variables were associated with pretreatment or post-treatment protocol deviations.
Results
During the study, 557 patients (mean age 70, 52% male, median National Institutes of Health Stroke Scale score 12) were treated with tPA. Protocol deviations occurred in 233 (42%) patients: 16% had pretreatment deviations, 35% had post-treatment deviations, and 9% had both. The most common protocol deviations included elevated post-treatment blood pressure, antithrombotic agent use within 24 hours of treatment, and elevated pretreatment blood pressure. Protocol deviations were not associated with sICH, stroke severity, or hospital factors. Older age was associated with pretreatment protocol deviations (adjusted odds ratio [OR], .52; 95% confidence interval [CI], .30-.92). Pretreatment deviations were associated with post-treatment deviations (adjusted OR, 3.20; 95% CI, 1.91-5.35).
Conclusions
Protocol deviations were not associated with sICH. Aside from age, patient and hospital factors were not associated with protocol deviations.