Key points in stroke diagnosis at the prehospital stage and the impact of the therapeutic timeframe on clinical outcomes

Abstract

Background. The critical time in stroke is the optimal period for administering thrombolysis, which restores blood flow to the brain and prevents permanent damage. The expression “time is brain” emphasizes the critical importance of early medical involvement, since every minute significantly impacts patient outcomes. Objective(s). Analysis of the importance of early diagnosis of stroke in the prehospital phase and the impact of the critical time on the development, treatment, and prognosis of patients. Materials and methods. The study analyzed national and international literature, including scientific articles and clinical guidelines, focusing on tools to extend the optimal therapeutic timeframe in acute stroke. Data were supplemented with information on algorithms and checklists used by the prehospital emergency service in Moldova, forming the basis of the analysis. Results. At the prehospital stage, rapid identification of stroke is vital for prompt initiation of treatment and reduction of complications. For this purpose, standardized scales such as FAST, CPSS, RACE, and NIHSS are used, which allow fast identification of the symptomatology. The treatment used in the first 3 hours significantly increases the chances of a favorable outcome. Due to the risk of aggravation, hospitalization in intensive care or specialized centers is essential. Reducing treatment time by 30 minutes raises the chance of a Rankin score 0-1 at 90 days by 1.8%, and cutting "door-to-needle" time by 10 minutes adds 0.2% to good outcome. Conclusion(s). Timely therapeutic intervention is important for the effective treatment of acute ischemic stroke. Early administration of intravenous thrombolysis and mechanical thrombectomy has proven effective in minimizing cerebral damage, enhancing functional recovery, and reducing mortality.