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

Sung,  Chang Min; Kim,  Eui Chung; Yoon,  Yoo Sang; Chung,  Hyun Soo; Park,  In Cheol; Heo,  Ji Hoe

J Korean Soc Emerg Med > Volume 17(5); 2006 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2006;17(5): 424-430.

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

Chang Min Sung, Eui Chung Kim, Yoo Sang Yoon, Hyun Soo Chung, In Cheol Park, Ji Hoe Heo

¹Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. incheol@yumc.yonsei.ac.kr
²Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea.
³Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.

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.

Key words: Medical Records, Stroke, Cerebral Infarction