2023
Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke
Man S, Solomon N, Mac Grory B, Alhanti B, Uchino K, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Hussain M, Fonarow G. Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke. Circulation 2023, 148: 20-34. PMID: 37199147, PMCID: PMC10356148, DOI: 10.1161/circulationaha.123.064053.Peer-Reviewed Original ResearchConceptsIntravenous thrombolytic therapyAcute ischemic strokeGood long-term functional outcomeLong-term functional outcomeShorter DTN timesEndovascular thrombectomyFunctional outcomeDTN timeIschemic strokeCause mortalityNeedle timeThrombolytic therapyCox proportional hazards modelModified Rankin Scale (mRS) 0Older US patientsRankin Scale 0Multivariate logistic regressionProportional hazards modelLongitudinal functional outcomesHome timeEligible patientsEVT candidatesEVT timesGuidelines-StrokeThrombolytic administration
2021
Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention
Xian Y, Xu H, Smith E, Saver J, Reeves M, Bhatt D, Hernandez A, Peterson E, Schwamm L, Fonarow G. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke 2021, 53: 1328-1338. PMID: 34802250, DOI: 10.1161/strokeaha.121.035853.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeProportion of patientsIschemic strokeNeedle timeSymptom onsetClinical outcomesNationwide quality improvement initiativePhase IBenefits of tPAGuidelines-Stroke hospitalsMedian DTN timeSecond intervention periodStroke symptom onsetQuality improvement interventionsQuality improvement initiativesPhase IIQuality Improvement ProgramHigh rateMinutes preinterventionBleeding complicationsHospital mortalityDTN timeHospital arrivalTPA useTherapy start
2020
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics
Zachrison K, Natsui S, Luan Erfe B, Mejia N, Schwamm L. Language preference does not influence stroke patients' symptom recognition or emergency care time metrics. The American Journal Of Emergency Medicine 2020, 40: 177-180. PMID: 33168382, DOI: 10.1016/j.ajem.2020.10.064.Peer-Reviewed Original ResearchConceptsResearch Patient Data RegistrySymptom recognitionDTN timeHospital arrivalSymptom discoveryAIS patientsEMS utilizationGuidelines-Stroke registryPatients' language preferenceConsecutive AIS patientsPatient Data RegistryUse of EMSEmergency medical servicesLanguage preferenceAcute strokeNeedle timeSymptom onsetEP patientsData registryAcademic centersPatientsPrior reportsMedical servicesSignificant differencesRegistryImpact of Emergency Department Crowding on Delays in Acute Stroke Care
Jaffe T, Goldstein J, Yun B, Etherton M, Leslie-Mazwi T, Schwamm L, Zachrison K. Impact of Emergency Department Crowding on Delays in Acute Stroke Care. Western Journal Of Emergency Medicine 2020, 21: 892-899. PMID: 32726261, PMCID: PMC7390586, DOI: 10.5811/westjem.2020.5.45873.Peer-Reviewed Original ResearchConceptsAcute stroke careStroke careED crowdingEndovascular therapyConsecutive acute ischemic stroke patientsCare deliveryAcute ischemic stroke patientsGroin puncture timeGuidelines-Stroke registryStroke care deliveryHealth Stroke ScaleIschemic stroke patientsMultiple clinical factorsUrban academic EDInitial stroke severityHigh ED utilizationSingle-institution analysisAcute care deliveryEmergency stroke careOutcomes of interestWilcoxon rank sum testEmergency department (ED) crowdingRank sum testAlteplase deliveryDTN time
2017
Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network
Moreno A, Schwamm L, Siddiqui K, Viswanathan A, Whitney C, Rost N, Zachrison K. Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network. Telemedicine Journal And E-Health 2017, 24: 678-683. PMID: 29271703, PMCID: PMC6014912, DOI: 10.1089/tmj.2017.0252.Peer-Reviewed Original ResearchConceptsDTN timePatient presentationTelestroke consultsTelestroke networkPatient-level regression analysesAcute ischemic stroke patientsShorter DTN timesIschemic stroke patientsFrequent contactPrimary predictor variableMedian DTNTPA administrationNeedle timeTPA useSpoke hospitalsStroke patientsMore frequent contactsHub hospitalImproved outcomesMedian numberTPA deliveryPatientsHospitalRegression analysisTelestrokeTimely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated
Sauser Zachrison K, Levine D, Fonarow G, Bhatt D, Cox M, Schulte P, Smith E, Suter R, Xian Y, Schwamm L. Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003148. PMID: 28283469, PMCID: PMC5369604, DOI: 10.1161/circoutcomes.116.003148.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngioplasty, Balloon, CoronaryDelivery of Health Care, IntegratedFemaleFibrinolytic AgentsHumansMaleMiddle AgedMyocardial ReperfusionOrganizational ObjectivesPatient Care TeamProspective StudiesQuality ImprovementQuality Indicators, Health CareRegistriesST Elevation Myocardial InfarctionStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorUnited StatesConceptsST-segment elevation myocardial infarctionAcute ischemic strokeDTN timeD2B timeTimely reperfusionMyocardial infarctionHospital CompareGuidelines-Coronary Artery DiseaseHospital performanceHierarchical linear regression modelingEligible patientsGuidelines-StrokeNeedle timeSTEMI patientsBalloon timeIschemic strokeArtery diseaseHospital proportionLinear regression modelingProspective studyHospital differencesAIS carePatientsCare processesSpearman's rank correlation coefficientUse of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice
Xian Y, Xu H, Lytle B, Blevins J, Peterson E, Hernandez A, Smith E, Saver J, Messé S, Paulsen M, Suter R, Reeves M, Jauch E, Schwamm L, Fonarow G. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003227. PMID: 28096207, DOI: 10.1161/circoutcomes.116.003227.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHumansInfusions, IntravenousPractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeConceptsNational quality improvement initiativeGuidelines-Stroke hospitalsAcute ischemic strokeDTN timeIntravenous tPAIschemic strokeNeedle timeTissue-type plasminogen activator administrationMedian DTN timeIschemic stroke patientsEmergency medical services (EMS) providersQuality improvement initiativesTissue-type plasminogen activatorHospital arrivalSymptom onsetStroke patientsMedical service providersClinical practiceHospitalPatientsMost hospitalsPlasminogen activatorPhase IStrokeImprovement initiatives
2014
Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative
Fonarow G, Zhao X, Smith E, Saver J, Reeves M, Bhatt D, Xian Y, Hernandez A, Peterson E, Schwamm L. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA 2014, 311: 1632-1640. PMID: 24756513, DOI: 10.1001/jama.2014.3203.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaDecision Support Systems, ClinicalFemaleFibrinolytic AgentsGuideline AdherenceHospital MortalityHospitalsHumansIntracranial HemorrhagesMaleMiddle AgedPatient DischargeQuality ImprovementRegistriesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeConceptsAcute ischemic strokeQuality improvement initiativesTissue plasminogen activatorNational quality improvement initiativeSymptomatic intracranial hemorrhageDTN timeTPA administrationIntracranial hemorrhagePostintervention periodIschemic strokeNeedle timeClinical outcomesPreintervention periodImprovement initiativesHospital risk-adjusted mortalityIntravenous tissue plasminogen activatorTissue plasminogen activator administrationMedian DTN timePercentage of patientsProportion of patientsClinical decision support toolRisk-adjusted mortalityGuidelines-StrokeHospital mortalityYear preinterventionStrategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke
Xian Y, Smith E, Zhao X, Peterson E, Olson D, Hernandez A, Bhatt D, Saver J, Schwamm L, Fonarow G. Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke. Stroke 2014, 45: 1387-1395. PMID: 24713527, DOI: 10.1161/strokeaha.113.003898.Peer-Reviewed Original ResearchConceptsShorter DTN timesAcute ischemic strokeTissue-type plasminogen activatorDTN timeIschemic strokePlasminogen activatorIntravenous tissue-type plasminogen activatorTissue-type plasminogen activator treatmentTissue-type plasminogen activator administrationGuidelines-Stroke hospitalsMedian DTN timePlasminogen activator treatmentHospital strategiesNeedle timeSymptom onsetMultivariable analysisBaseline useEmergency departmentRapid doorActivator treatmentHospitalStrokeActivation systemAssociationActivatorImproving Door-to-Needle Times
Ruff I, Ali S, Goldstein J, Lev M, Copen W, McIntyre J, Rost N, Schwamm L. Improving Door-to-Needle Times. Stroke 2014, 45: 504-508. PMID: 24399372, DOI: 10.1161/strokeaha.113.004073.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overClinical ProtocolsComorbidityData Interpretation, StatisticalEarly DiagnosisEmergency Medical ServicesFemaleFibrinolytic AgentsHumansInternational Classification of DiseasesMaleMiddle AgedProspective StudiesQuality ImprovementRetrospective StudiesSocioeconomic FactorsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsIntravenous tissue-type plasminogen activatorEmergency department arrivalTissue-type plasminogen activatorAcute strokeDTN timeNeedle timeHealth Stroke Scale scorePlasminogen activatorAcute ischemic strokePercentage of patientsStroke Scale scoreAmerican Heart AssociationStroke care modelWilcoxon signed-rank testImproving DoorIschemic strokeStroke guidelinesHeart AssociationPostintervention periodSigned-rank testPre interventionCare modelNational guidelinesPost interventionPatients