Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke

Abstract

Background and PurposeTimely intravenous (IV) thrombolysis for acute ischemic stroke is associated with better clinical outcomes. Acute stroke care implemented with “Stroke Code” (SC) may increase IV tissue plasminogen activator (tPA) administration. The present study aimed to investigate the impact of SC on thrombolysis.MethodsThe study period was divided into the “pre-SC era” (January 2006 to July 2010) and “SC era” (August 2010 to July 2013). Demographics, critical times (stroke symptom onset, presentation to the emergency department, neuroimaging, thrombolysis), stroke severity, and clinical outcomes were recorded and compared between the two eras.ResultsDuring the study period, 5957 patients with acute ischemic stroke were admitted; of these, 1301 (21.8%) arrived at the emergency department within 3 h of stroke onset and 307 (5.2%) received IV-tPA. The number and frequency of IV-tPA treatments for patients with an onset-to-door time of <3 h increased from the pre-SC era (n = 91, 13.9%) to the SC era (n = 216, 33.3%) (P<0.001). SC also improved the efficiency of IV-tPA administration; the median door-to-needle time decreased (88 to 51 min, P<0.001) and the percentage of door-to-needle times ≤60 min increased (14.3% to 71.3%, P<0.001). The SC era group tended to have more patients with good outcome (modified Rankin Scale ≤2) at discharge (49.5 vs. 39.6%, P = 0.11), with no difference in symptomatic hemorrhage events or in-hospital mortality.ConclusionThe SC protocol increases the percentage of acute ischemic stroke patients receiving IV-tPA and decreases door-to-needle time.

Time cost of a nonclosing intravenous thrombolysis service for acute ischemic stroke

“…10 In total, 115 patients were treated with intravenous thrombolysis for acute ischemic stroke between May 2008 and December 2010, 10 which is comparable to the 91 patients who were treated at the National Taiwan University Hospital between January 2006 and July 2010. 11 The safety and efficacy of treatment are comparable to those in other Asian and Western countries. 10,12 An in-hospital case management program to improve the quality of stroke care according to clinical guidelines was implemented in CCH in 2008.…”

Improving Door-to-Needle Times for Acute Ischemic Stroke

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“…CT indicates computed tomography; ED, emergency department; EMS, emergency medical services; ID, identification; NIHSS, National Institutes of Health Stroke Scale; and tPA, tissue-type plasminogen activator. by guest on May 12, 2018 http://circoutcomes.ahajournals.org/ Downloaded from Improving IV tPA Door-to-Needle Time institutional protocol differs from many others in that all tissue-type plasminogen activator-eligible or -treated patients go immediately from the CT scanner to the stroke unit if they are medically stable. They are transported back to the ED only if additional emergency treatment is required, such as intubation.…”

“…by guest on May 12, 2018 http://circoutcomes.ahajournals.org/ Downloaded from Improving IV tPA Door-to-Needle Time patients as unknown, adopting a protocol already in use for high priority trauma patients who are also usually unable to identify themselves because of depressed consciousness or severe pain. When witnesses arrive and the patient identity is later confirmed, the unique unknown number is then linked to the actual patient ID.…”

“…by guest on May 12, 2018 http://circoutcomes.ahajournals.org/ Downloaded from Improving IV tPA Door-to-Needle Time on EMS stretcher; (3) whether the patient was registered as unknown; and (4) whether the STAT stroke prenotification protocol was used.…”