Thrombolysis and its implications in the management of stroke in the accident and emergency department.
OBJECTIVE
Examination of initial management of stroke patients in the emergency setting to assess feasibility of thrombolysis for acute ischaemic stroke.


METHODS
Retrospective analysis of all patients presenting with a clinical diagnosis of stroke over a two month period. Exclusion criteria for thrombolysis were applied to assess the number of patients that would potentially have been eligible for thrombolysis.


RESULTS
Of 94 patients identified with clinical stroke, only 57 (60.6%) had a CT scan; 23 (24.4%) were confirmed as having had an acute ischaemic stroke. Mean delay in scanning was 2.2 days (range 0-15 days). Even if all patients had presented and been scanned within three hours (as required for thrombolysis), only six (6.4%) patients would have been eligible for thrombolysis.


CONCLUSIONS
The great majority of patients presenting with clinical stroke do not fulfill the criteria for thrombolysis. Current practice involves significant delays in CT scanning, which has implications for resource structuring should thrombolysis become widely available.
Department of Accident and Emergency Medicine and Surgery, Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW.
O
O
Quaba
C E
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Robertson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012606:Scotland; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome