Acute stroke treatment in a local city ～an example in Kochi Prefecture～

Abstract

In the acute treatment of cerebral ischemic stroke, intravenous alteplase infusion therapy and mechanical thrombectomy should be carried out rapidly. The treatment algorithm named “stroke scramble” was started from 2015 at Kochi Health Sciences Center to perform consistent team medical care completed in the shortest time.

The emergency physician declared the start of the scramble. By the patient arrival, the patient condition including each item of GAI₂AA scale was evaluated and intravenous alteplase therapy and mechanical thrombectomy were carried out as soon as possible. To keep the acute medical system, the patients were transferred to the other hospitals soon after the acute treatment.

As the result, door–to–needle time was reduced from 84 to 42 minutes. After the introduction of GAI₂AA scale in March 2017, door–to–puncture time was reduced from 91 to 52 minutes. The average length of hospital stay decreased by about 3 days from 21.4 in 2014 to 18.4 in 2019. The stroke scramble and its resemblant algorithm was activated in the whole Kochi Prefecture due to the open information to the other hospitals.

Since the medical care system is limited in local cities, it is important to establish high–efficient and stereotyped team medical care. Close cooperation under comprehensible slogans such as the stroke scramble could be useful.