Acute Ischemic Stroke Clinical Trial
Official title:
Impact Of A Training Program And Organization On The Management Of Stroke In The Acute Phase (AVC-II)
Acute stroke management represents a true medical emergency that requires prompt diagnosis
and urgent treatment. In a previous exhaustive cohort study conducted in the Rhône region,
France (AVC69) (Porthault et al. 2013) the investigators observed that only a small
percentage of patients could access to thrombolysis in time. In this cohort of 1306 patients
treated in one of the emergency department of the Rhone region for a suspected stroke, 84%
of patients reached hospital through an emergency department instead of going directly to a
stroke unit. Among those patients, only 2% were finally thrombolysed. A significant part of
patients arrived in the emergency department too late to be thrombolysed. However, among the
subset of ischemic stroke patients who reach emergency department less than 3 hours after
symptoms onset, and who had no clinical or radiological exclusion criteria for thrombolysis,
only 15 % were thrombolysed. The hypothesis was that an intervention designed to improve ED
professional's knowledge and skills and to develop together efficient clinical pathway would
decrease door-to imaging time and consequently door-to needle time and eventually improve
overall thrombolysis rate.
The investigators have conducted a cluster randomized controlled stepped wedge trial. All
adult patients with suspected stroke arriving in one of the participating ED were included
in the study along five successive four-month periods. The program featured: development of
written materials (booklets) and video (film), and one day session of standardized training
for trainers, at least one nurse and one physician of all EDs, with formal presentation to
improve knowledge, and simulation to improve skills for using the "FAST" tool (nurses) and
the "NIHSS" score (ED physicians). Additionally, a clinical pathway was developed to adapt
general evidence based guidelines to the local organization. The primary outcome is the
door-to imaging time.
n/a
Time Perspective: Prospective
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