on behalf of the China National Stroke Registry (CNSR) InvestigatorsBackground and Purpose-Little is known about intravenous recombinant tissue plasminogen activator (rtPA) use in China. By accessing the Chinese National Stroke Registry (CNSR), the rate of intravenous rtPA use was reviewed. We specifically examined the issues of prehospital and in-emergency department delay and compared them with the published data from developed countries. Methods-Funded by Chinese government, CNSR is the only nationwide stroke registry that includes 132 urban hospitals.All patients eligible for intravenous rtPA were included for analysis. We then compared the onset-to-needle time and door-to-needle time in the emergency department in China with those in developed countries. Key Words: registries Ⅲ stroke Ⅲ thrombolytic therapy S troke is the second leading cause of death after cancer in the world. 1 However, stroke has become the leading cause of death among all diseases in China, which has one fifth of the total population in the world. Currently, Ͼ7 million Chinese have strokes, and approximately 65% of them are ischemic. Rising incidence and morbidity of stroke have created a heavy burden to the Chinese healthcare system. 2-4 Since its approval in the United States in 1996, intravenous recombinant tissue plasminogen activator (rtPA) has been used in treating acute ischemic stroke (AIS) for Ͼ15 years in developed countries. 5 With the reported rate of using rtPA between 1.2% and 9%, 6 -8 their experiences have identified many barriers of giving rtPA such as prehospital or in-hospital delay, short treatment time window, and lack of hospital infrastructure and readiness. Delay in presentation is the most common reason for exclusion. Many studies found that only approximately 20% to 25% of patients with acute stroke arrived in the hospital within 3 hours. 6
Results-From
Case Enrollment and Target Population
Data Collection and ManagementAll research coordinators and study investigators were trained and certified to assess National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale before the beginning of the trial. Trained research coordinators at each site reviewed medical records daily and identified, consented, and enrolled all eligible patients. A paper-based registry form developed by the advisory panel was used for data collection. Information collected included patient demographics, use of emergency medical services, the time of symptom onset and arrival at the ED, initial brain imaging, NIHSS scores, prestroke modified Rankin Scale, medical history, diagnosis, stroke management, and discharge status. Type of thrombolytics and doses, intravenous (IV), intra-arterial (IA), or IV and IA combination, treatment time, and reasons for not giving thrombolytic therapies were also recorded.At each site, all data elements from each paper-based registry form were manually checked for completeness, correct coding, and proper application of diagnostic algorithm by a research specialist who had experience in c...