Clinical audit of stroke thrombolysis in Wellington, New Zealand: disparity between in-hours and out-of-hours treatment time

• Published in: New Zealand medical journal Vol. 125; no. 1349; pp. 30 - 36
• Main Authors: Thorne, Katie, Wong, Lai-Kin, McGonigal, Gerard
• Format: Journal Article
• Language: English
• Published: New Zealand 10.02.2012
• Subjects: Adult; After-Hours Care - standards; After-Hours Care - statistics & numerical data; Aged; Aged, 80 and over; Female; Fibrinolytic Agents - therapeutic use; Healthcare Disparities - statistics & numerical data; Humans; Male; Medical Audit; Middle Aged; New Zealand; Stroke - drug therapy; Stroke - mortality; Thrombolytic Therapy - standards; Thrombolytic Therapy - statistics & numerical data; Time Factors; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; New Zealand
• ISSN: 1175-8716

To report on the safety and efficiency of a comprehensive stroke thrombolysis service and look for evidence of disparity between in-hours and out-of-hours treatment times. Clinical audit of patients treated with tissue plasminogen activator, alteplase (rt-PA) for stroke at Wellington Hospital between 1 November 2009 and 31 October 2010. Thirty-one patients were treated with rt-PA. All were treated within agreed clinical eligibility criteria. The median NIHSS score pre-treatment was 10; post treatment 5. Two patients died, both from intracranial haemorrhage. Overall the average time to treatment from symptom onset was 168 minutes. Those treated out-of-hours had an additional delay of 33 minutes compared to in-hours treatment (p=0.03). Patients admitted out-of-hours had significantly longer delays to rt-PA treatment. Those planning Stroke Services should ensure this source of inequity is addressed within their localities.