Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke: strength of association
Corrrespondence / American Journal of Emergency Medicine 35 (2017) 342–371
Masahiko Hara, MD, PhD
Department of cardiovascular medicine, Osaka City University Graduate
School of Medicine, Osaka, Japan
345
Erfan Ayubi, MSc, PhDc
Department of Epidemiology School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
http://dx.doi.org/10.1016/j.ajem.2016.10.083
Impact of an emergency medicine
pharmacist on Time to thrombolysis in acute ischemic stroke: Strength of association?
To the Editor,
We were interested to read the valuable article by Montgomery and colleagues [1] that was published in the American Journal of Emergency Medicine in July 2016. In this article, the authors investigated the effect of an emergency department pharmacist on time on thrombolytic ad- ministration in patients with acute ischemic stroke. The results were very interesting; however, it is important to keep in mind to derive bet- ter view from the strength of association of an emergency medicine pharmacist and time to thrombolysis, and we should estimate relative measures such as odds ratio (OR).
We estimated the OR of Thrombolysis in more than 60 minutes when the emergency department pharmacist was participating on the stroke alert team (PHARM group) compared with the NON- PHARM group using the presented data in the article of Montgomery et al. The OR (95% confidence interval) of thrombolysis in more than 60 minutes compared with Thrombolysis in less than 60 minutes in PHARM group was 0.26 (0.10-0.62). In addition, the OR (95% CI) of thrombolysis in more than 60 minutes compared with Thrombolysis in less than 45 minutes in the PHARM group was 0.31 (0.12-0.78). So, our result showed that the PHARM group can reduce the odds of thrombolysis in more than 60 minutes by 0.74 when the reference group is thrombolysis in less than 60 minutes. In addition, the PHARM group reduced the odds of thrombolysis in more than 60 mi- nutes by 0.69 when the reference group is thrombolysis in less than 45 minutes.
A take-home message for readers is that relative measures such as OR and risk ratio are easy-to-understand indicators that provide a better view from the etiology of a given factor [2].
Acknowledgment
The authors would like to thanks the statistics consultants of Research Development Center of Sina Hospital for their technical assistance. This work was not supported by any organization.
Saeid Safiri, PhD Managerial Epidemiology Research Center, Department of Public Health School of Nursing and Midwifery, Maragheh University of Medical Sciences
Maragheh, Iran Road Traffic Injury Research Center, Department of Statistics & Epidemiology
Tabriz University of Medical Sciences, Tabriz, Iran
Mohadeseh Sani, BS
School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
Department of Epidemiology & Biostatistics, School of Public Health, Tehran
University of Medical Sciences, Tehran, Iran Corresponding author at: Department of Epidemiology School of Public Health, Shahid Beheshti
University of Medical Sciences Tehran 6446-14155, Iran Tel./fax: +98 21 88989127
E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.10.041
- Montgomery K, Hall AB, Keriazes G. Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke. Am J Emerg Med 2016;34:1997-9.
- Sani M, Ayubi E, Mansori K, Khazaei S. Seventy-two-hour antibiotic retrieval from the ED: reporting the strength of association. Am J Emerg Med 2016;34:1909-10.
Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic
stroke: strength of association?,??,?
To the Editor,
We appreciate your insight and review of our manuscript in the American Journal of Emergency Medicine [1]. We acknowledge that measures such as odds ratio (OR) or relative risk may help the reader further understand the strength of association of our outcomes.
Our patients were divided into the following 2 groups: a pharm group when a pharmacist was participating on the stroke alert team and a non- pharm group when the pharmacist was not participating. Overall, our re- sults displayed a favorable impact of a pharmacist’s participation on the stroke alert team. We agree that the OR of thrombolysis in more than 60 minutes compared with less than 60 minutes is 0.26 with a 95% confi- dence interval (0.11-0.62). However, when calculating the OR of throm- bolysis in more than 60 minutes compared with less than 45 minutes, we found an OR of 0.21 (0.08-0.58).
Using our numbers, we found that the emergency department pharmacist may reduce the odds of thrombolysis in more than 60 minutes by 0.74 when the reference group is less than 60 minutes. Similarly, an emergency department pharmacist may reduce the odds of thrombolysis in more than 60 minutes by 0.79 when the reference group is less than 45 minutes.
Kayla Montgomery, PharmD, BCPS
A. Brad Hall, PharmD
Department of Emergency Medicine, Lakeland Regional Health
Lakeland, FL E-mail address: [email protected] (K. Montgomery)
[email protected] (A. Brad Hall) http://dx.doi.org/10.1016/j.ajem.2016.10.040
[1] Montgomery K, Hall AB, Keriazes G. Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke. Am J Emerg Med 2016 Oct;34(10): 1997-9.
? Conflict of interest: The authors have nothing to disclose.
? Meetings: Not applicable.
?? Support/grant: Not applicable.
? Conflicts of interest: Nothing to disclose.