Intravenous thrombolysis for ischaemic stroke: short delays and high community-based treatment rates after organisational changes in a previously inexperienced centre

• Published in: Emergency medicine journal : EMJ Vol. 26; no. 5; pp. 324 - 326
• Main Authors: Tveiten, A, Mygland, Å, Ljøstad, U, Thomassen, L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.05.2009; BMJ Publishing Group LTD
• Subjects: Adult; Age; Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Confidence intervals; Delivery of Health Care - organization & administration; Drug Utilization - statistics & numerical data; Emergency medical care; Emergency Medical Services - organization & administration; Female; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Norway; Prospective Studies; Statistical analysis; Stroke; Stroke - drug therapy; Thrombolytic Therapy - methods; Time Factors; Tissue Plasminogen Activator - therapeutic use; Norway
• DOI: 10.1136/emj.2008.063610
• ISSN: 1472-0205

Aim:To evaluate hospital delays in thrombolytic treatment before and after organisational changes and community-based treatment rates in a previously inexperienced centre.Methods:The delays before and after organisational changes made in 2006 were compared using a prospective treatment database. In a 6-month period in 2007, a community-based search was performed for all hospitalisations for ischaemic stroke. The number of patients admitted within the 0–3 h time window and the proportion treated with tissue plasminogen activator were analysed.Results:The number of treatments increased fourfold from 2005 to 2007 with a significant reduction in mean door-to-needle time from 60 min to 38 min (p = 0.002). In the community-based series, 14/137 patients (10%) hospitalised with ischaemic stroke and 13/32 patients (41%) admitted in the 0–3 h window were treated.Conclusions:An inexperienced stroke centre can rapidly implement the necessary logistics to deliver thrombolysis to a large proportion of patients with acute stroke with short hospital delays. Important factors are probably prenotification of a team and the initiation of thrombolytic treatment in the emergency room.