Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial
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(2020) 20:432
RESEARCH ARTICLE
Open Access
Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial Md Golam Hasnain1* , Christine L. Paul1, John R. Attia1,2,3, Annika Ryan1, Erin Kerr3, Christopher Oldmeadow2, Catherine A. D’Este1,4, Andrew Bivard5, Isobel J. Hubbard1, Abul Hasnat Milton6 and Christopher R. Levi1,7
Abstract Background: Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia. Methods: A posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0–2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5–6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups. Results: There was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56– 2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52). Conclusion: The TIPS multi-component implementation approach was not effective in reducing the odds of posttreatment severe disability at 90 days, or post-thrombolysis hemorrhage. Trial registration: Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN1261300093 9796. Keywords: Ischemic stroke, Intravenous thrombolysis, Implementation intervention, Clinical outcome
* Correspondence: [email protected] 1 School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if c
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