Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience

• Published in: Clinical neurology and neurosurgery Vol. 115; no. 9; pp. 1583 - 1585
• Main Authors: Joux, Julien, Olindo, Stéphane, Girard-Claudon, Annette, Chausson, Nicolas, Saint-Vil, Martine, Signate, Aissatou, Edimonana, Mireille, Jeannin, Severine, Aveillan, Mathieu, Cabre, Philippe, Smadja, Didier
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2013; Elsevier Limited
• Subjects: Aged; Ambulance; Ambulances; Diabetes; Emergency medical care; Emergency Medical Services - methods; Family physicians; Female; Fibrinolytic Agents - therapeutic use; Fire stations; Fires; France; Humans; Magnetic Resonance Imaging; Male; Medical imaging; Medicalization; Middle Aged; Mobile Health Units; Neurology; Neurosurgery; NMR; Nuclear magnetic resonance; Patient Care Team; Patient Transfer - methods; Patients; Physicians; Prehospital; Prospective Studies; Risk Factors; Standard deviation; Stroke; Stroke - diagnosis; Stroke - drug therapy; Thrombolysis; Thrombolytic Therapy; Tissue Plasminogen Activator - therapeutic use; France; Stroke; Medicalization; Ambulance; Thrombolysis; Prehospital
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2013.02.010

Abstract Objectives Narrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study. Patients and methods Intrahospital processing times and t-PA treatment were analyzed in stroke patients calling within 6 h and admitted in our stoke unit. Patients transferred by our mobile medical team (SAMU) and by Fire Department (FD) paramedics were compared. Results 193 (61.6%) SAMU patients and 120 (38.4%) FD patients were included within 30 months. Clinical characteristics and onset-to-call intervals were similar in the two groups. Mean door-to-imaging delay was deeply reduced in the SAMU group (52 vs. 159 min, p < 0.0001) and was <25 min in 50% of SAMU patients and 14% of FD patients ( p < 0.0001). SAMU management was the only independent factor of early imaging ( p = 0.0006). t-PA administration rate was higher in SAMU group than in FD group (42% vs. 28%, p = 0.04). Proportion of patients with delayed therapeutic window was higher in FD group than in SAMU group (38% vs. 26%, p < 0.0001). Conclusion Prehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke.