Screening with MRI for Accurate and Rapid Stroke Treatment: SMART.
Screening with MRI for Accurate and Rapid Stroke Treatment: SMART.
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: It is feasible and practical to consistently and rapidly deliver IV tPA to AIS patients within national benchmark times using MRI as the routine screening modality. The processes used in the SMART (Screening with MRI for Accurate and Rapid Stroke Treatment) Study to reduce DTN time have the potential to be widely applicable to other hospitals.Copyright � 2015 American Academy of Neurology. METHODS: Quality improvement processes were initiated in 2013 to reduce door-to-needle (DTN) time at the 2 hospitals where the NIH stroke team provides clinical care. Acute ischemic stroke (AIS) patients who received IV tissue plasminogen activator (tPA) <4.5 hours from last known normal were identified. Demographic and clinical characteristics and timing metrics were analyzed comparing the time periods before, during, and after the quality improvement processes. OBJECTIVE: The objective of this study was to demonstrate the feasibility of timely multimodal MRI screening before thrombolysis in acute stroke patients. RESULTS: There were 157 patients treated with IV tPA for AIS during 2012-2013, of whom 135 (86%) were screened with MRI. DTN time was significantly reduced by 40% during this period from a median of 93 minutes in the first half of 2012 to 55 minutes in the last half of 2013 (p < 0.0001) with a significant 4-fold increase in the proportion of treated patients with DTN time <60 minutes from 13.0% to 61.5%, respectively (p < 0.00001). Improvement in DTN time was associated with reduced door-to-MRI time, and there were no differences in demographic or clinical characteristics (p = 0.21-0.76).
English
0028-3878
*Brain Ischemia/th [Therapy]
*Brain/pa [Pathology]
*Fibrinolytic Agents/ad [Administration & Dosage]
*Magnetic Resonance Imaging/mt [Methods]
*Stroke/th [Therapy]
*Tissue Plasminogen Activator/ad [Administration & Dosage]
Acute Disease
Administration, Intravenous
Aged
Aged, 80 and over
Brain Ischemia/di [Diagnosis]
Brain Ischemia/pa [Pathology]
Feasibility Studies
Female
Humans
Male
Middle Aged
Multimodal Imaging/mt [Methods]
Quality Improvement
Stroke/di [Diagnosis]
Stroke/pa [Pathology]
Time-to-Treatment
MedStar Washington Hospital Center
Neurology
Journal Article
Research Support, N.I.H., Intramural
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: It is feasible and practical to consistently and rapidly deliver IV tPA to AIS patients within national benchmark times using MRI as the routine screening modality. The processes used in the SMART (Screening with MRI for Accurate and Rapid Stroke Treatment) Study to reduce DTN time have the potential to be widely applicable to other hospitals.Copyright � 2015 American Academy of Neurology. METHODS: Quality improvement processes were initiated in 2013 to reduce door-to-needle (DTN) time at the 2 hospitals where the NIH stroke team provides clinical care. Acute ischemic stroke (AIS) patients who received IV tissue plasminogen activator (tPA) <4.5 hours from last known normal were identified. Demographic and clinical characteristics and timing metrics were analyzed comparing the time periods before, during, and after the quality improvement processes. OBJECTIVE: The objective of this study was to demonstrate the feasibility of timely multimodal MRI screening before thrombolysis in acute stroke patients. RESULTS: There were 157 patients treated with IV tPA for AIS during 2012-2013, of whom 135 (86%) were screened with MRI. DTN time was significantly reduced by 40% during this period from a median of 93 minutes in the first half of 2012 to 55 minutes in the last half of 2013 (p < 0.0001) with a significant 4-fold increase in the proportion of treated patients with DTN time <60 minutes from 13.0% to 61.5%, respectively (p < 0.00001). Improvement in DTN time was associated with reduced door-to-MRI time, and there were no differences in demographic or clinical characteristics (p = 0.21-0.76).
English
0028-3878
*Brain Ischemia/th [Therapy]
*Brain/pa [Pathology]
*Fibrinolytic Agents/ad [Administration & Dosage]
*Magnetic Resonance Imaging/mt [Methods]
*Stroke/th [Therapy]
*Tissue Plasminogen Activator/ad [Administration & Dosage]
Acute Disease
Administration, Intravenous
Aged
Aged, 80 and over
Brain Ischemia/di [Diagnosis]
Brain Ischemia/pa [Pathology]
Feasibility Studies
Female
Humans
Male
Middle Aged
Multimodal Imaging/mt [Methods]
Quality Improvement
Stroke/di [Diagnosis]
Stroke/pa [Pathology]
Time-to-Treatment
MedStar Washington Hospital Center
Neurology
Journal Article
Research Support, N.I.H., Intramural