J Korean Soc Emerg Med.  2006 Oct;17(5):424-430.

Diagnosis and Treatment of Patients With Acute Neurologic Symptoms Using a Coordinated Response Protocol

• Sung CM
• Kim EC
• Yoon YS
• Chung HS
• Park IC
• Heo JH

Abstract

PURPOSE: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential.
METHODS
Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital's ED with an acute neurologic symptoms and an onset time of less than 12 hours.
RESULTS
Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47+/-19 minutes and 26+/-12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96+/-16 minutes and 67+/-28 minutes, respectively (pvalue=0.035).
CONCLUSION
Assembly of a specific "stroke team"and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.

Keyword

Medical Records; Stroke; Cerebral Infarction

MeSH Terms

Cerebral Infarction
Diagnosis*
Emergencies
Emergency Service, Hospital
Humans
Male
Medical Records
Neurologic Manifestations*
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Urokinase-Type Plasminogen Activator
Tissue Plasminogen Activator
Urokinase-Type Plasminogen Activator