title: Lack of t-PA use for acute ischemic stroke in a community hospital: high incidence of exclusion criteria.
abstract: Thrombolytic therapy with t-PA for acute ischemic stroke may provide benefit in long-term outcome. This retrospective study was undertaken to evaluate appropriateness of the National Institute of Neurological Disorders and Stroke (NINDS) protocol in the emergency department (ED). All patients with appropriate International Classification of Diseases, 9th revision (ICD-9) codes indicating stroke who presented to our 387-bed trauma-I community hospital during 1997 were included in the study. Of the nearly 35,000 patients screened, 201 patients satisfied our inclusion criteria. Mean age was 73.5 +/- 13.3 years. Men were evaluated and transported to computed tomography more rapidly and older patients more slowly. Nonwhites were more likely to arrive via emergency medical services (EMS). Average time from EMS arrival at scene to ED arrival was 22.7 minutes, and from ED arrival to triage was 8.4 minutes. The most common reason for exclusion from t-PA administration was delayed presentation (n = 188); this is the most serious barrier to use of t-PA for acute ischemic stroke. Extensive public education may combat this.
authors.affiliation: Department of Emergency Medicine, Mercy Medical Center, Rockville Centre, NY 11570, USA.
authors.forename: E
authors.initials: E
authors.lastname: Engelstein
authors.forename: J
authors.initials: J
authors.lastname: Margulies
authors.forename: J S
authors.initials: JS
authors.lastname: Jeret
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications*; D002985:Clinical Protocols; D003953:Diagnosis-Related Groups / Q000145:classification; D004363:Drug Utilization; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009518:New York; D018579:Patient Selection; D011859:Radiography; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014193:Trauma Centers
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator