ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2019
Prehospital and Emergency Department-Focused Mission Protocol Improves Thrombolysis Metrics for Suspected Acute Stroke Patients.
Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 3 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 3 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Effect of implementing care protocols on acute ischemic stroke outcomes: a systematic review.Arquivos de neuro-psiquiatria · 2023Pooled it
- Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review.International journal of environmental research and public health · 2022Pooled it
- Reducing care time after implementing protocols for acute ischemic stroke: a systematic review.Arquivos de neuro-psiquiatria · 2022Pooled it
- A clinical activation protocol improves response time to urgent/emergent neurosurgical care in children with brain tumors and intracranial hemorrhage.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- The Contribution of the Triage Nurse in the Optimisation of Door-to-Computed-Tomography Time in Stroke.Nursing reports (Pavia, Italy) · 2024Article
- Large vessel occlusion prediction scales provide high negative but low positive predictive values in prehospital suspected stroke patients.BMJ neurology open · 2022Article
- Clinical significance of stroke nurse in patients with acute ischemic stroke receiving intravenous thrombolysis.BMC neurology · 2021Article
- A Comparison of Time to Treatment between an Emergency Department Focused Stroke Protocol and Mobile Stroke Units.Prehospital and disaster medicine · 2021Article
- Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand.International journal of emergency medicine · 2021Article
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe Mission Protocol was implemented in 2017 to expedite stroke evaluation and reduce door-to-needle (DTN) times at Zuckerberg San Francisco General Hospital. The key system changes were team-based evaluation of suspected stroke patients at ambulance entrance by an Emergency Department (ED) physician, ED nurse, and neurologist and immediate emergency medical service (EMS) provider transport of patients to CT.
methodsPatients were eligible for a Mission Protocol prehospital stroke activation if an EMS provider found a positive Cincinnati Prehospital Stroke Scale and a last known normal time within 6 hours. We retrospectively compared treatment metrics between the first year of Mission Protocol patients and patients from the year prior also brought in via ambulance with suspected stroke and a last known normal time within 6 hours. Median Door to CT and DTN times were compared using 2 sample Wilcoxon rank-sum (Mann-Whitney) tests.
resultsThere were 236 patients in the Mission Protocol group and 112 in the comparison group. The Mission Protocol was associated with a 10 minutes faster median door to CT time (P < .00001), a 6 minutes faster median DTN time (P = .0046), a 22% increase in the proportion of patients treated within 45 minutes of arrival (84% versus 62%), and a 12% increase in the proportion of patients treated within 60 minutes (92% versus 80%). There were 8 stroke mimics treated in the Mission Protocol cohort compared to 2 in the comparison cohort. Symptomatic intracranial hemorrhage occurred in one Mission Protocol patient with an ischemic stroke.
conclusionsThe EMS direct to CT based Mission Protocol was associated with faster median door to CT and DTN times. There was a 22% increase in the proportion of thrombolysis patients treated within 45 minutes or less. More stroke mimic patients received thrombolysis but symptomatic intracranial hemorrhage only occurred in 1 ischemic stroke patient.
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