| dc.contributor.advisor | Psychogios, Marios-Nikos Prof. Dr. | |
| dc.contributor.author | Sahlmann, Imke | |
| dc.date.accessioned | 2024-02-05T07:33:13Z | |
| dc.date.available | 2024-03-14T00:50:08Z | |
| dc.date.issued | 2024-02-05 | |
| dc.identifier.uri | http://resolver.sub.uni-goettingen.de/purl?ediss-11858/15100 | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-10331 | |
| dc.format.extent | 85 | de |
| dc.language.iso | deu | de |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
| dc.subject.ddc | 610 | de |
| dc.title | Standardisierte Zeitintervalle im Management von Patienten mit akutem ischämischen Schlaganfall: prognostische und prädiktive Bedeutung | de |
| dc.type | doctoralThesis | de |
| dc.title.translated | Standardized time intervals in the management of patients with acute ischemic stroke: prognostic and predictive significance | de |
| dc.contributor.referee | Psychogios, Marios-Nikos Prof. Dr. | |
| dc.date.examination | 2024-02-15 | de |
| dc.description.abstracteng | Background: The importance of efficient stroke time management on the clinical outcome of thrombectomized patients has been demonstrated by numerous controlled randomized trials (RCT). Although time is an important predictor of outcome - in accordance with the paradigm “Time is brain“ - the most important time points Door, Imaging, Groin and Reperfusion have not yet been standardized. This results in limited comparability of the available studies. The aim of this work is to examine the meaning of the different definitions and standardization of the time points.
Methods: Three methods with differently defined start and end time points (Door, Imaging, Groin and Reperfusion which are based on the RCTs) have been retrospectively determined for each patient (n = 250; average age 73 years (SD ± 13.3); 56.1% female; period 01/2014 - 10/2017; data from the stroke archive of the University Medical Center Göttingen) per time period (Door-to-Imaging, Imaging-to-Groin, Groin-to-Reperfusion, Door-to-Groin, Door-to-Reperfusion and Imaging-to-Reperfusion). A total of 18 differently defined time periods were examined for differences using analyzes of variance and logistic regression models and were compared with regard to their association with the outcome (mRS and ASPECTS).
Results: There are statistically detectable differences between the in-hospital time periods if the times are not standardized. Statistical differences within the three measurement methods exist particularly in the time periods from Groin-to-Reperfusion and Imaging-to-Reperfusion (e.g. 17 minutes versus 40 minutes or 44.5 minutes, respectively; p < 0.001). The Groin-to-Reperfusion and Door-to-Imaging time periods appear to have a predictive influence on the outcome (mRS at discharge and post-ASPECT score) in three of a total of 18 different definitions. Furthermore, the covariates age, NIHSS score on admission, anesthesia and intravenous thrombolysis appear to be statistically associated with the mRS score at discharge, and the covariable smoking with the post-ASPECT score.
Discussion: Current stroke management is only comparable to a limited extent due to a lack of standardization. The existing time intervals suggest limitations in transferability if data were collected from studies with different definitions. The following standardized times, based primarily on clinical experience and due to their practicality in everyday clinical practice, are recommended: Door = SAP time; Imaging = first cCT native; Groin = groin puncture (CT fluoroscopy time); Reperfusion = first series mTICI 2b/3. Due to the retrospective, single-centered study design, the validity of the measurement methods used is limited. Prospective studies to test the hypotheses and recommendations should follow. | de |
| dc.contributor.coReferee | Wasser, Katrin PD Dr. | |
| dc.subject.eng | neuroradiology | de |
| dc.subject.eng | ischemic stroke | de |
| dc.subject.eng | efficient stroke management | de |
| dc.subject.eng | standardized time intervals | de |
| dc.subject.eng | thrombectomy | de |
| dc.identifier.urn | urn:nbn:de:gbv:7-ediss-15100-8 | |
| dc.affiliation.institute | Medizinische Fakultät | de |
| dc.subject.gokfull | Radiologie / Bildgebende Verfahren / Ultraschall / Nuklearmedizin / Strahlenschutz - Allgemein- und Gesamtdarstellungen (PPN619875585) | de |
| dc.description.embargoed | 2024-03-14 | de |
| dc.identifier.ppn | 1880245426 | |
| dc.notes.confirmationsent | Confirmation sent 2024-02-05T07:45:01 | de |