{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:13:08Z","timestamp":1786122788042,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurol. Int.","Neurology International"],"abstract":"<jats:p>Introduction: Stroke remains a leading cause of mortality and long-term disability worldwide. Coordinated care delivered through protocol-driven multidisciplinary teams enables rapid diagnosis and treatment, both of which are essential for improving clinical outcomes. Objective: Our objective was to analyze care strategies in the emergency management of acute ischemic stroke, focusing on treatment times and influencing factors, interventions implemented in emergency settings and their impact on clinical outcomes, and the contribution of healthcare professionals to optimizing stroke care. Methods: A systematic review was conducted in accordance with the PRISMA 2020 Statement. Current evidence published between 2021 and 2026 was retrieved from five databases: PubMed, Web of Science, Scopus, Cochrane Library, and SciELO. Eligibility criteria were applied, and methodological quality and risk of bias were assessed using validated appraisal tools. Results: Fourteen studies involving a total of 6384 patients were included. Factors such as healthcare system reorganization, multidisciplinary teamwork, early protocol activation, and the use of stroke-specific triage scales significantly influenced treatment times. Coordinated and protocolized care pathways, together with evidence-based clinical interventions, were consistently associated with higher thrombolysis rates and shorter treatment times, while improvements in neurological and functional recovery were reported in several, but not all, studies. The integration of specialized stroke professionals and structured emergency care processes contributed to reducing treatment delays and improving patient outcomes. Conclusions: Critical treatment times in acute ischemic stroke are influenced by multiple factors, and targeted organizational and clinical strategies can accelerate diagnosis and treatment. Although improvements in clinical outcomes were not consistently demonstrated across all included studies, the available evidence consistently supports protocol-driven multidisciplinary emergency care as an effective strategy for reducing treatment delays and optimizing acute ischemic stroke management.<\/jats:p>","DOI":"10.3390\/neurolint18080148","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:44:53Z","timestamp":1786103093000},"page":"148","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Care Strategies in Emergency Management of Acute Ischemic Stroke: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Paula","family":"S\u00e1nchez-Fernandez","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9915-0567","authenticated-orcid":false,"given":"\u00c1lvaro","family":"Astasio-Picado","sequence":"additional","affiliation":[{"name":"Physiotherapy, Nursing and Physiology Department, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Toledo, Spain"},{"name":"Intensive Care Unit, Hospital Virgen del Puerto, 10600 Plasencia, Spain"},{"name":"Faculty of Economics and Business, Universitat Oberta de Catalunya, 09018 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2379-9620","authenticated-orcid":false,"given":"Jes\u00fas","family":"Jurado-Palomo","sequence":"additional","affiliation":[{"name":"Physiotherapy, Nursing and Physiology Department, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","first-page":"454","article-title":"An\u00e1lisis de los factores relacionados con el tiempo prehospitalario en la atenci\u00f3n al ictus","volume":"33","author":"Trigueros","year":"2021","journal-title":"Emergencias"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e20220791","DOI":"10.1590\/0034-7167-2022-0791","article-title":"Nursing theories in the care of stroke patients: A scoping review","volume":"76","year":"2023","journal-title":"Rev. Bras. Enferm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.nrleng.2020.07.026","article-title":"Management of acute stroke. Specific nursing care and treatments in the stroke unit","volume":"38","author":"Sanjuan","year":"2023","journal-title":"Neurolog\u00eda (Engl. Ed.)"},{"key":"ref_4","unstructured":"Ministerio de Sanidad (2026, January 01). Estrategia en Ictus del Sistema Nacional de Salud: Actualizaci\u00f3n 2024, Available online: https:\/\/www.sanidad.gob.es\/areas\/calidadAsistencial\/estrategias\/ictus\/docs\/Estrategia_en_Ictus_del_SNS._Actualizacion_2024_accesible.pdf."},{"key":"ref_5","unstructured":"Gobierno de Arag\u00f3n, Departamento de Sanidad (2026, January 01). Plan de Atenci\u00f3n al Ictus en Arag\u00f3n: Actualizaci\u00f3n 2024, Available online: https:\/\/www.aragon.es\/documents\/d\/guest\/plan-ictus-2024-modificado-julio-2024."},{"key":"ref_6","unstructured":"Oyanguren Rode\u00f1o, B., Eimil Ortiz, M., Gonz\u00e1lez Salaices, M., and Ja\u00e9n Casares, V. (2015). Atenci\u00f3n Hospitalaria del Paciente con Ictus, Medical & Marketing Communications. Available online: https:\/\/www.amn-web.com\/documentos\/manual-para-enfermeria-en-ictus.pdf."},{"key":"ref_7","unstructured":"SESCAM (2026, January 01). C\u00f3digo Ictus Castilla-La Mancha Estrategia de Reperfusi\u00f3n en el Ictus 2023. Available online: https:\/\/scmneurologia.com\/files\/codigo_ictus_clm_2023_maquetado_12b.0.pdf."},{"key":"ref_8","unstructured":"SESCAM (2026, January 01). C\u00f3digo Ictus Castilla-La Mancha Estrategia de Reperfusi\u00f3n en el Ictus 2015. Available online: https:\/\/sanidad.castillalamancha.es\/files\/documentos\/pdf\/20150626\/codigo_ictus_clm_2015_docfinal_100615.pdf."},{"key":"ref_9","unstructured":"GBD 2019 Stroke Collaborators (2021). Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol., 20, 795\u2013820."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke"},{"key":"ref_11","first-page":"167","article-title":"Prehospital care process and hospital outcomes in stroke-code cases: Comparison of basic and advance life support ambulance attendance","volume":"35","author":"Azeli","year":"2023","journal-title":"Emergencias"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1161\/STR.0000000000000357","article-title":"Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association","volume":"52","author":"Green","year":"2021","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.nrl.2012.12.009","article-title":"Tratamiento endovascular en el ictus isqu\u00e9mico agudo. Plan de Atenci\u00f3n al Ictus en la Comunidad de Madrid","volume":"28","author":"Egido","year":"2013","journal-title":"Neurolog\u00eda"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.recesp.2021.06.016","article-title":"Declaraci\u00f3n PRISMA 2020: Una gu\u00eda actualizada para la publicaci\u00f3n de revisiones sistem\u00e1ticas","volume":"74","author":"Page","year":"2021","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jclinepi.2015.06.005","article-title":"ROBIS: A new tool to assess risk of bias in systematic reviews was developed","volume":"69","author":"Whiting","year":"2016","journal-title":"J. Clin. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jclinepi.2023.06.015","article-title":"Risk-of-bias assessment using Cochrane\u2019s revised tool for randomized trials (RoB 2) was useful but challenging and resource-intensive: Observations from a systematic review","volume":"161","author":"Crocker","year":"2023","journal-title":"J. Clin. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jclinepi.2021.08.022","article-title":"Cochrane\u2019s risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review","volume":"140","author":"Campbell","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","unstructured":"Plaza Moreno, E. (PrismaFlow Studio, 2026). PrismaFlow Studio, Version 1.0.0."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1111\/imj.15429","article-title":"The quest to reduce stroke treatment delays at a Melbourne metropolitan primary stroke centre over the past two decades","volume":"52","author":"Park","year":"2022","journal-title":"Intern. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/JNN.0000000000000590","article-title":"Factors that Influence Door-to-Needle Administration for Acute Stroke Patients in the Emergency Department","volume":"53","author":"Davis","year":"2021","journal-title":"J. Neurosci. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.3390\/nursrep14030131","article-title":"The Contribution of the Triage Nurse in the Optimisation of Door-to-Computed-Tomography Time in Stroke","volume":"14","author":"Antunes","year":"2024","journal-title":"Nurs. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/1742-6723.14369","article-title":"Time is brain, so we must BEFAST: Improving stroke identification and triage in a rural emergency department","volume":"36","author":"Jay","year":"2024","journal-title":"Emerg. Med. Australas."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2561793","DOI":"10.1080\/07853890.2025.2561793","article-title":"Impact of timeline-based management on treatment efficiency and outcomes in acute ischemic stroke: A quasi-experimental study","volume":"57","author":"Li","year":"2025","journal-title":"Ann. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4407","DOI":"10.1080\/02648725.2023.2210954","article-title":"Application effect of prehospital-hospital integrated emergency nursing in patients with acute cerebral infarction","volume":"40","author":"Chen","year":"2024","journal-title":"Biotechnol. Genet. Eng. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3233\/NRE-210310","article-title":"An emergency nursing and monitoring procedure on cognitive impairment and neurological function recovery in patients with acute cerebral infarction","volume":"51","author":"Xie","year":"2022","journal-title":"NeuroRehabilitation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"18","DOI":"10.14715\/cmb\/2023.69.8.3","article-title":"Management of Acute Cerebral Infarction by Intravenous Thrombolysis with Recombinant T Cell Receptor and Plasminogen Activator and Association of Emergency Nursing Route in the Prognosis","volume":"69","author":"Liu","year":"2023","journal-title":"Cell. Mol. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2890","DOI":"10.1002\/brb3.2890","article-title":"Effects of predictive nursing intervention on cognitive impairment and neurological function in ischemic stroke patients","volume":"13","author":"Xue","year":"2023","journal-title":"Brain Behav."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jen.2022.01.013","article-title":"Outcomes From a Nursing-Driven Acute Stroke Care Protocol for Telehealth Encounters","volume":"48","author":"Olson","year":"2022","journal-title":"J. Emerg. Nurs."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zhan, T., and Xu, C. (2025). Impact of emergency nursing interventions on pre-hospital and in-hospital outcomes in acute ischemic stroke. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1673515"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"108216","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.108216","article-title":"Effects of stroke nurse-led acute stroke management on treatment time benchmarks, intravenous thrombolysis rates, and patient outcomes: A systematic review and meta-analysis","volume":"34","author":"Kumar","year":"2025","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Xu, Z.H., Deng, Q.W., Zhai, Q., Zhang, Q., Wang, Z.J., Chen, W.X., Gu, M.-M., Jiang, T., Zhou, J.-S., and Zhang, Y.-D. (2021). Clinical significance of stroke nurse in patients with acute ischemic stroke receiving intravenous thrombolysis. BMC Neurol., 21.","DOI":"10.1186\/s12883-021-02375-6"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1002\/nop2.1101","article-title":"Practice of integrated treatment process for acute ischaemic stroke in hospital coordinated by emergency stroke nurses","volume":"9","author":"Li","year":"2022","journal-title":"Nurs. Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. 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