PMID- 22464507
OWN - NLM
STAT- MEDLINE
DCOM- 20120612
LR  - 20140912
IS  - 0256-9574 (Print)
VI  - 102
IP  - 4
DP  - 2012 Mar 7
TI  - Door-to-needle time for administration of fibrinolytics in acute myocardial 
      infarction in Cape Town.
PG  - 241-4
AB  - OBJECTIVES: To determine the current door-to-needle time for the administration 
      of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) 
      at three hospitals in Cape Town, and to compare it with the American Heart 
      Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes 
      as a marker of quality of care. METHODS: A retrospective review of case notes 
      from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in 
      the ECs of three Cape Town hospitals. The total door-to-needle time was 
      calculated and patient demographics and presentation, physician qualification, 
      clinical symptomology and reasons for delays in thromobolytic administration were 
      analysed. RESULTS: A total of 372 patients with acute ST elevation myocardial 
      infarction (STEMI) were identified; 161 patients were eligible for the study. The 
      median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A 
      door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 
      51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 
      12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical 
      officers administered thrombolytics to 44.7% of the patients. The predominant 
      infarct location on ECG was inferior (55.9%). CONCLUSION: A significant number of 
      patients were not thrombolysed within 30 minutes of presentation. The lack of 
      senior doctors, difficulty interpreting ECGs, atypical presentations and EC 
      system delays prolonged the door-to-needle time in this study.
FAU - Maharaj, Roshen C
AU  - Maharaj RC
AD  - Division of Emergency Medicine, University of Cape Town. roshenmaharaj@gmail.com
FAU - Geduld, Heike
AU  - Geduld H
FAU - Wallis, Lee A
AU  - Wallis LA
LA  - eng
PT  - Journal Article
DEP - 20120307
PL  - South Africa
TA  - S Afr Med J
JT  - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
JID - 0404520
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Clinical Competence
MH  - Delayed Diagnosis
MH  - Emergency Service, Hospital/*standards/statistics & numerical data
MH  - Female
MH  - Fibrinolytic Agents/*administration & dosage
MH  - Humans
MH  - Male
MH  - Medical Audit
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*drug therapy
MH  - Quality Indicators, Health Care
MH  - Referral and Consultation
MH  - Retrospective Studies
MH  - South Africa
MH  - Thrombolytic Therapy/*standards/statistics & numerical data
MH  - Time Factors
EDAT- 2012/04/03 06:00
MHDA- 2012/06/13 06:00
CRDT- 2012/04/03 06:00
PHST- 2011/08/10 00:00 [received]
PHST- 2011/08/16 00:00 [accepted]
PHST- 2012/04/03 06:00 [entrez]
PHST- 2012/04/03 06:00 [pubmed]
PHST- 2012/06/13 06:00 [medline]
PST - epublish
SO  - S Afr Med J. 2012 Mar 7;102(4):241-4.