Evidence map›Paper›PMID 29247142›Full record

Trial reportStroke2018

Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System.

Mai N Nguyen-Huynh, Jeffrey G Klingman, Andrew L Avins, Vivek A Rao, Abigail Eaton, Sunil Bhopale, Anne C Kim, John W Morehouse, Alexander C Flint, KPNC Stroke FORCE Team

Abstract readClinical TrialComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
47citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

47 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  17. Global stroke statistics 2023: Availability of reperfusion services around the world.International journal of stroke : official journal of the International Stroke Society · 2024
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mai N Nguyen-HuynhFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.). Mai.N.Nguyen-Huynh@kp.org.
Jeffrey G KlingmanFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
Andrew L AvinsFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
Vivek A RaoFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
Abigail EatonFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
Sunil BhopaleFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
Anne C KimFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
John W MorehouseFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
Alexander C FlintFrom the Division of Research, Kaiser Permanente Northern California, Oakland (M.N.N.-H., A.L.A., A.C.F., A.E.); Departments of Neuroscience (A.C.F., V.A.R.) and Emergency Medicine (S.B.), Kaiser Permanente, Redwood City, CA; Departments of Neurology (M.N.N.-H., J.G.K.) and Radiology (A.C.K.), Kaiser Permanente, Walnut Creek, CA; and Department of Emergency Medicine, Kaiser Permanente, Oakland, CA (J.W.M.).
KPNC Stroke FORCE Team

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeFaster treatment with intravenous alteplase in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California redesigned its acute stroke workflow across all 21 Kaiser Permanente Northern California stroke centers to (1) follow a single standardized version of a modified Helsinki model and (2) have all emergency stroke cases managed by a dedicated telestroke neurologist. We examined the effect of Kaiser Permanente Northern California's Stroke EXpediting the PRrocess of Evaluating and Stopping Stroke program on door-to-needle (DTN) time, alteplase use, and symptomatic intracranial hemorrhage rates.

methodsThe program was introduced in a staggered fashion from September 2015 to January 2016. We compared DTN times for a seasonally adjusted 9-month period at each center before implementation to the corresponding 9-month calendar period from the start of implementation. The primary outcome was the DTN time for alteplase administration. Secondary outcomes included rate of alteplase administrations per month, symptomatic intracranial hemorrhage, and disposition at time of discharge.

resultsThis study included 310 patients treated with alteplase in the pre-EXpediting the PRrocess of Evaluating and Stopping Stroke period and 557 patients treated with alteplase in the EXpediting the PRrocess of Evaluating and Stopping Stroke period. After implementation, alteplase administrations increased to 62/mo from 34/mo at baseline (

conclusionsIntroduction of a standardized modified Helsinki protocol across 21 hospitals using telestroke management was associated with increased alteplase administrations, significantly shorter DTN times, and no increase in adverse outcomes.

Indexed as

StrokeAgedAged, 80 and overCaliforniaDelivery of Health Care, IntegratedFemaleHumansMaleMiddle AgedTelemedicineThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTissue Plasminogen Activatoracute stroke careintracranial hemorrhagesstroketelemedicinetime-to-treatmenttissue-type plasminogen activator

Identifiers

PMID29247142
PMCPMC5753819

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.