Effect of prehospital workflow optimization on treatment delays and clinical outcomes in acute ischemic stroke: A systematic review and meta?analysis

Background The prehospital phase is critical in ensuring that stroke treatment delivered quickly and a major source of time delay. This study sought to identify examine workflow optimizations (PSWOs) their impact on improving health systems, reperfusion rates, delays, clinical outcomes. Methods authors conducted systematic literature review meta-analysis by extracting data from several research databases (PubMed, Cochrane, Medline, Embase) published since 2005. We used appropriate key search terms studies concerning optimization, following Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) guidelines. Results identified 27 articles looked at the parameters; 26 were included meta-analysis. PSWO subgrouped into three categories: improved intravenous thrombolysis (IVT) triage, large-vessel occlusion (LVO) bypass, mobile unit (MSU). salient findings are as follows: IVT triage led significantly rates (relative risk [RR] = 1.80, 95% confidence interval [CI] 1.18 2.75); however, MSU did not (RR 1.22, CI 0.98 1.52). Improved (standard mean difference [SMD] –0.82, –1.32 –0.32), LVO bypass (SMD –0.80, –1.13 –0.47), –0.87, –1.57 –0.17) found reduce door-to-needle IVT. was call-to-needle –1.41, –1.94 –0.88) onset-to-needle –1.15, –1.74 –0.56) times additionally demonstrated significant reduction door-to-perfusion –0.72, –0.12) well call-to-perfusion –0.73, –1.08 –0.38) EVT. Finally, demonstrate improvements good functional outcome 1.04, 0.97 1.12) or mortality 90 days 1.00, 0.76 1.31). Conclusions improves metrics related leading improvement rates. Thus, implementation these measures networks promising avenue improve an often-neglected aspect response. However, limited available suggest outcomes PSWO; hence, further strategies vis-à-vis PSWOs warranted.