Turk J Cerebrovasc Dis. 2025; 31(2): 82-86 | DOI: 10.5505/tjcvd.2025.27048

Evaluation of Diagnostic and Treatment Timelines for Ischemic Stroke Patients in the Emergency Department: A Prospective Observational Study

Elif Reyhan Solmaz¹, Engin Özakýn², Atilla Özcan Özdemir³, Nurdan Acar², Muhammed Evvah Karakýlýç², Filiz Baloðlu Kaya², Mustafa Emin Çanakcý², Çaðlar Kuas², Volkan Ercan^2
1Department of Emergency Medicine, Eskiþehir City Hospital, Eskiþehir, Türkiye
²Department of Emergency Medicine, Faculty of Medicine, Eskiþehir Osmangazi University, Eskiþehir, Türkiye
³Department of Neurology, Faculty of Medicine, Eskiþehir Osmangazi University, Eskiþehir, Türkiye

INTRODUCTION: This study aimed to evaluate the diagnostic and treatment processes of patients presenting with ischemic stroke to the Emergency Department of Eskisehir Osmangazi University Faculty of Medicine Hospital, identify workflow deficiencies, and propose improvement strategies.
METHODS: This prospective and observational study included 592 patients aged 18 years or older who were diagnosed with ischemic stroke in the emergency department. Demographic data of patients admitted to the emergency department and diagnosed with ischemic stroke, their backgrounds, vital signs at the time of first presentation to the emergency department, emergency department management processes (electrocardiography, fingerstick blood glucose, consultation calls and completion times, Computed tomography (CT) and CT angiography acquisition and reporting times, treatment (intravenous thrombolytic therapy (IV tPA) and endovascular therapy (EVT) initiation times and transfer times to the stroke unit were recorded.
RESULTS: The mean age of the patients was 68.28±13.09 years, and 53.7% were male. Reperfusion therapy (rtPA and/or EVT) was administered to 25.1% of the patients. The mean door-to-doctor time was 2.00±0.91 minutes, and the mean door-to-CT time was 22.36±16.79 minutes. Diagnostic and treatment processes were significantly faster in patients receiving reperfusion therapy (P<.001). The primary factor delaying rtPA administration was the arrival time of the consultant physician to the emergency department.
DISCUSSION AND CONCLUSION: Timely and effective management of diagnostic and treatment processes in ischemic stroke patients significantly reduces mortality and morbidity. Coordinated teamwork between emergency and stroke units and process optimization may enhance the success of stroke management.

Keywords: Ischemic stroke, door-to-needle time, thrombolytic therapy, endovascular.

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Acil Serviste Ýskemik Ýnme Hastalarýnýn Taný ve Tedavi Sürelerinin Deðerlendirilmesi: Prospektif Gözlemsel Çalýþma

Elif Reyhan Solmaz¹, Engin Özakýn², Atilla Özcan Özdemir³, Nurdan Acar², Muhammed Evvah Karakýlýç², Filiz Baloðlu Kaya², Mustafa Emin Çanakcý², Çaðlar Kuas², Volkan Ercan^2
1Eskiþehir Þehir Hastanesi, Acil Servis, Eskiþehir, Türkiye
²Eskiþehir Osmangazi Üniversitesi, Týp Fakültesi, Acil Týp Anabilim Dalý, Eskiþehir, Türkiye
³Eskiþehir Osmangazi Üniversitesi, Týp Fakültesi, Nöroloji Anabilim Dalý, Eskiþehir, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmada, Eskiþehir Osmangazi Üniversitesi, Týp Fakültesi Hastanesi Acil Servisi’ne baþvuran iskemik inme hastalarýnýn taný ve tedavi süreçlerinin deðerlendirilmesi, süreçlerdeki aksaklýklarýn belirlenmesi ve iyileþtirme önerilerinin sunulmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Prospektif ve gözlemsel olarak planlanan çalýþmaya, 18 yaþ üzeri, acil serviste iskemik inme tanýsý alan 592 hasta dahil edilmiþtir Acil servise baþvuran ve iskemik inme tanýsý alan hastalarýn demografik verileri, özgeçmiþleri, acil servise ilk baþvuru anýndaki vital bulgularý, acil servis yönetim süreçleri (elektrokardiografi çekimi, parmak ucu kan þekeri, konsültasyon çaðrýlarý ve tamamlanma süreleri, bilgisayarlý tomografi (BT) ve BT anjiografi çekimi ve raporlanma süreleri, tedaviye (intravenöz trombolitik tedavi (IV tPA) ve endovasküler tedavi (EVT) baþlama süreleri ile inme ünitesine transfer zamanlarý kayýt altýna alýnmýþtýr.
BULGULAR: Çalýþmaya katýlan hastalarýn ortalama yaþý 68,28±13,09 yýl olup %53,7’si erkekti. Hastalarýn %25,1’ine reperfüzyon tedavisi (rtPA ve/veya EVT) uygulandý. Kapý-doktor süresi ortalama 2,00±0,91 dk, kapý-BT süresi 22,36±16,79 dk olarak saptandý. Reperfüzyon tedavisi uygulanan hastalarda taný ve tedavi süreçleri anlamlý þekilde daha hýzlýydý (P<.001). rtPA uygulama süresini en çok etkileyen faktör konsültan hekimin acil servise gelme süresi olarak belirlendi.
TARTIÞMA ve SONUÇ: Ýskemik inmeli hastalarda taný ve tedavi süreçlerinin zamanýnda ve etkin yürütülmesi mortalite ve morbiditeyi azaltmaktadýr. Acil servis ve inme ekiplerinin koordineli çalýþmasý ve süreç optimizasyonu, inme yönetiminde baþarýyý artýrabilir.

Anahtar Kelimeler: Ýskemik inme, kapý-iðne süresi, trombolitik tedavi, endovasküler tedavi.

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