Analysis of the impact of an Emergency Medical Services system on reducing in-hospital delay to intravenous thrombolysis and improving outcomes in acute ischemic stroke
LI Jiangtao
WANG Chengjian
REN Luhui
JIANG Nana
SUN Yulin
Abstract：Objective To evaluate the effect of Emergency Medical Services(EMS)activation combined with intravenous thrombolysis on outcomes in patients with acute ischemic stroke(AIS),and to identify factors contributing to in-hospital delays.Methods In this retrospective cohort study,86 AIS patients admitted to Hai-yang Hospital of Traditional Chinese Medicine from January 2023 to January 2025 were included.Based on the stroke fast-track activation mode,patients were divided into an EMS-activated group(prehospital EMS activa-tion;n=43)and an ED-activated group(in-hospital emergency department activation;n=43).Outcomes compared between groups included door-to-needle time(DNT),neurological function(National Institutes of Health Stroke Scale,NIHSS),activities of daily living(Barthel Index,BI),cognitive function(Mini-Mental State Examination,MMSE),emergency treatment efficacy,complication rates,and in-hospital delay intervals with associated fac-tors.Results The EMS-activated group had a significantly shorter DNT than the ED-activated group(P＜0.001),with a higher proportion achieving DNT ≤60 minutes(93.02％vs.76.74％,P=0.035).The overall effective rate of emergency treatment was higher in the EMS-activated group(95.35％vs.79.07％,P=0.024).After treatment,the EMS-activated group showed lower NIHSS scores and higher BI and MMSE scores compared with the ED-acti-vated group(P＜0.001).The overall complication rate was lower in the EMS-activated group(4.65％vs.20.93％,P=0.044).In multivariable analysis,EMS activation was an independent protective factor for shorter DNT(β=-10.524,P＜0.001),whereas longer CT comple-tion-to-report time(β=0.856,P＜0.001)and longer re-port-to-risk disclosure time for thrombolysis(β=1.234,P＜0.001)were independent risk factors for prolonged DNT.Conclusion In AIS care,EMS activation significantly shortens DNT,improves neurological function,activities of daily living,and cognitive outcomes,and reduces the risk of complications.Multivariable analysis in-dicates that EMS activation itself is key to efficiency,while CT reporting and clinician-patient risk communication are major in-hospital bottlenecks;these steps should be prioritized for optimization in clinical practice.
Keywords：Medical servicesIntravenous thrombolysisAcute ischemic stroke
Publication Date：2025-08-28
Online Publishing Date：2026-01-06(First online date of this platform, not the publication date of the document)
Pages：5( 943-947 )