INTRODUCTION: Stroke is one of the main neurological emergencies and, in the healthcare context, is a highly complex and time-dependent condition. Timely diagnostic and therapeutic intervention is crucial to reducing mortality and improving functional outcomes, as every minute of ischemia results in irreversible loss of brain tissue. In this scenario, nurses play a key role in the pre-hospital and in-hospital management of patients, ensuring early recognition of neurological signs, activation of the stroke code, and continuity of care until the patient reaches the stroke unit. The study aims to analyze the effectiveness and evolution of the nursing operating model in the early management of acute ischemic stroke within the Ascoli Piceno Local Health Authority. MATERIALS AND METHODS: A retrospective observational study was conducted on patients diagnosed with ischemic stroke who underwent pharmacological recanalization therapy using fibrinolysis and/or mechanical recanalization using thrombectomy at the Madonna del Soccorso Hospital in San Benedetto del Tronto, part of the Ascoli Piceno Local Health Authority (AST). RESULTS: In 2018, 62 patients with acute ischemic stroke were analyzed, of whom 33 were male (53%) and 29 were female (47%), while in 2024, the sample consisted of 112 patients, of whom 67 were male (60%) and 45 were female (40%). Most patients were transported by advanced emergency vehicle (AEV), increasing from 63% (n=39) in 2018 to 79% in 2024; followed by BEV 19% and 5%, LEV 5% and 3%, and autonomous 13% in both periods. Transfers to HUB facilities accounted for 85% in 2018 and 78% in 2024, while transfers to SPOKE facilities accounted for 2% and 10%. In terms of geographical origin, in 2018 the districts of San Benedetto del Tronto (42%) and Ascoli Piceno (21%) were the most prevalent, followed by Offida (11%), outside the region (5%), independent (13%) and unknown (8%); in 2024, the main areas are San Benedetto del Tronto (38%), Ascoli Piceno (28%), Offida (11%), autonomous (13%), outside the region (5%), unknown (2%) and Fermo (1%). The analysis of average times did not show any statistically significant differences between 2018 and 2024 (p>0.05). ANALYSIS: In the first phase, Microsoft Excel was used to describe the numerical variables. The descriptive analysis included absolute and relative frequencies (percentages) for categorical variables, and means, standard deviations, minimums, and maximums for numerical variables. In the second phase, the t-test for independent samples was used to assess the statistical significance of the differences observed between the years considered. DISCUSSIONS: The analysis highlights a significant evolution in the time-dependent pathway for acute ischemic stroke in the AST of Ascoli Piceno between 2018 and 2024, with a doubling of patients treated and an improvement, albeit not statistically significant, in time indicators. The reduction in door-to-imaging and door-to-needle times, the reorganisation of pathways and the performance of fibrinolysis in the ED have increased the efficiency and safety of treatment, with a decrease in haemorrhagic complications. The integration between MSA, C.O. 118, Emergency Room, and Stroke Unit, together with staff training and protocol standardization, has strengthened the quality of care and the role of nursing. Organizational and territorial critical issues remain, but the consolidation of an integrated network based on shared protocols and specialist skills is essential to ensure timely and high-quality care. KEYWORDS: “EMS Stroke”, “Ischemic Stroke”, “Stroke Management”, “Nurse and Stroke”.
INTRODUZIONE: L’ictus rappresenta una delle principali emergenze neurologiche e costituisce, nel contesto sanitario, una patologia ad elevata complessità assistenziale e fortemente tempo-dipendente. La tempestività dell’intervento diagnostico-terapeutico è determinante per ridurre la mortalità e migliorare gli esiti funzionali, poiché ogni minuto di ischemia comporta una perdita irreversibile di tessuto cerebrale (Powers, 2019). L’infermiere riveste un ruolo cardine nella gestione preospedaliera e intraospedaliera del paziente, assicurando il riconoscimento precoce dei segni neurologici, l’attivazione del codice stroke e la continuità assistenziale fino alla Stroke Unit (ESO & al, 2023). Lo studio intende analizzare l’efficacia e l’evoluzione dell’assistenza infermieristica nella gestione precoce dell’ictus ischemico acuto all’interno dell’AST di Ascoli Piceno. MATERIALI E METODI: È stato condotto uno studio osservazionale retrospettivo sui pazienti con diagnosi di ictus ischemico sottoposti a terapia ricanalizzante farmacologica mediante fibrinolisi e/o meccanica mediante trombectomia afferenti al P.O. di San Benedetto del Tronto dell’Azienda Sanitaria Territoriale (AST) di Ascoli Piceno. RISULTATI: Nel 2018 sono stati analizzati n. 62 pazienti affetti da ictus ischemico acuto, di cui 33 maschi (53%) e 29 femmine (47%), mentre nel 2024 il campione è risultato composto da 112 pazienti, di cui 67 maschi (60%) e 45 femmine (40%). La maggior parte dei pazienti è stata trasportata con mezzo di soccorso avanzato (MSA), in aumento dal 63% nel 2018 al 79% nel 2024; seguono MSB 19% e 5%, MSI 5% e 3%, autonomi 13% in entrambi i periodi. I trasferimenti verso presidio HUB sono stati pari all’85% nel 2018 e al 78% nel 2024, mentre verso SPOKE al 2% e 10%. La provenienza territoriale mostra nel 2018 prevalenza dei distretti di San Benedetto del Tronto (42%) e Ascoli Piceno (21%), seguiti da Offida (11%), fuori-regione (5%), autonomi (13%) e non noti (8%); nel 2024 le principali aree risultano San Benedetto del Tronto (38%), Ascoli Piceno (28%), Offida (11%), autonomi (13%), fuori-regione (5%), non noti (2%) e Fermo (1%). L’analisi dei tempi medi non ha evidenziato differenze statisticamente significative tra il 2018 e il 2024 (p>0,05). ANALISI: Nella prima fase, per la descrizione delle variabili numeriche, è stato utilizzato Microsoft Excel. L’analisi descrittiva ha incluso Frequenze assolute e relative (percentuali) per le variabili categoriali, Media, deviazione standard, minimo e massimo per le variabili numeriche. Nella seconda fase, per valutare la significatività statistica delle differenze osservate tra gli anni considerati, è stato utilizzato il t-test per campioni indipendenti. DISCUSSIONI: L’analisi evidenzia un’evoluzione significativa del percorso tempo-dipendente per l’ictus ischemico acuto nell’AST di Ascoli Piceno tra il 2018 e il 2024, con un raddoppio dei pazienti trattati e un miglioramento, seppur non statisticamente significativo, degli indicatori temporali. La riduzione dei tempi door-to-imaging e door-to-needle, la riorganizzazione dei percorsi e l’esecuzione della fibrinolisi in DEA hanno incrementato l’efficienza e la sicurezza del trattamento, con una diminuzione delle complicanze emorragiche. L’integrazione tra MSA, C.O. 118, Pronto Soccorso e Stroke Unit, insieme alla formazione del personale e alla standardizzazione dei protocolli, ha rafforzato la qualità assistenziale e il ruolo infermieristico. Restano criticità organizzative e territoriali, ma il consolidamento di una rete integrata basata su protocolli condivisi e competenze specialistiche è essenziale per garantire cure tempestive e di elevata qualità. KEYWORDS: “EMS Stroke”, “Ischemic Stroke”, “Stroke Management” , “Nurse and Stroke”.
LO SVILUPPO DI UN ATELIER PER UNA PRECOCE GOVERNANCE DELL’ICTUS ISCHEMICO: APPRENDIMENTO DEI FONDAMENTI DELL’AST DI ASCOLI PICENO
POMPEI, RICCARDO
2024/2025
Abstract
INTRODUCTION: Stroke is one of the main neurological emergencies and, in the healthcare context, is a highly complex and time-dependent condition. Timely diagnostic and therapeutic intervention is crucial to reducing mortality and improving functional outcomes, as every minute of ischemia results in irreversible loss of brain tissue. In this scenario, nurses play a key role in the pre-hospital and in-hospital management of patients, ensuring early recognition of neurological signs, activation of the stroke code, and continuity of care until the patient reaches the stroke unit. The study aims to analyze the effectiveness and evolution of the nursing operating model in the early management of acute ischemic stroke within the Ascoli Piceno Local Health Authority. MATERIALS AND METHODS: A retrospective observational study was conducted on patients diagnosed with ischemic stroke who underwent pharmacological recanalization therapy using fibrinolysis and/or mechanical recanalization using thrombectomy at the Madonna del Soccorso Hospital in San Benedetto del Tronto, part of the Ascoli Piceno Local Health Authority (AST). RESULTS: In 2018, 62 patients with acute ischemic stroke were analyzed, of whom 33 were male (53%) and 29 were female (47%), while in 2024, the sample consisted of 112 patients, of whom 67 were male (60%) and 45 were female (40%). Most patients were transported by advanced emergency vehicle (AEV), increasing from 63% (n=39) in 2018 to 79% in 2024; followed by BEV 19% and 5%, LEV 5% and 3%, and autonomous 13% in both periods. Transfers to HUB facilities accounted for 85% in 2018 and 78% in 2024, while transfers to SPOKE facilities accounted for 2% and 10%. In terms of geographical origin, in 2018 the districts of San Benedetto del Tronto (42%) and Ascoli Piceno (21%) were the most prevalent, followed by Offida (11%), outside the region (5%), independent (13%) and unknown (8%); in 2024, the main areas are San Benedetto del Tronto (38%), Ascoli Piceno (28%), Offida (11%), autonomous (13%), outside the region (5%), unknown (2%) and Fermo (1%). The analysis of average times did not show any statistically significant differences between 2018 and 2024 (p>0.05). ANALYSIS: In the first phase, Microsoft Excel was used to describe the numerical variables. The descriptive analysis included absolute and relative frequencies (percentages) for categorical variables, and means, standard deviations, minimums, and maximums for numerical variables. In the second phase, the t-test for independent samples was used to assess the statistical significance of the differences observed between the years considered. DISCUSSIONS: The analysis highlights a significant evolution in the time-dependent pathway for acute ischemic stroke in the AST of Ascoli Piceno between 2018 and 2024, with a doubling of patients treated and an improvement, albeit not statistically significant, in time indicators. The reduction in door-to-imaging and door-to-needle times, the reorganisation of pathways and the performance of fibrinolysis in the ED have increased the efficiency and safety of treatment, with a decrease in haemorrhagic complications. The integration between MSA, C.O. 118, Emergency Room, and Stroke Unit, together with staff training and protocol standardization, has strengthened the quality of care and the role of nursing. Organizational and territorial critical issues remain, but the consolidation of an integrated network based on shared protocols and specialist skills is essential to ensure timely and high-quality care. KEYWORDS: “EMS Stroke”, “Ischemic Stroke”, “Stroke Management”, “Nurse and Stroke”.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/24207