title: Tissue plasminogen activator for acute ischemic stroke: a New York city emergency medicine perspective.
abstract: Nationally, only 2-3% of patients with acute ischemic stroke (AIS) currently receive tissue plasminogen activator (TPA). To better understand the reasons, we investigated the practice patterns, level of familiarity and acceptance of TPA for AIS among emergency physicians in New York City (NYC). Fifty-seven 911-receiving hospital emergency department directors were surveyed regarding TPA use. Of those responding, 37% had never used TPA to treat AIS. Lack of neurological support was reported by 33%. Departments with formal protocols were more likely to use TPA for AIS. In conclusion, there is considerable variation in the practice, knowledge, and attitudes regarding the use of TPA for AIS in NYC emergency departments. Improved educational efforts and institutional support may be necessary to ensure the appropriate use of TPA by emergency physicians.
authors.affiliation: University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07101, USA.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Chan
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Kwiatkowski
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rella
authors.forename: William P
authors.initials: WP
authors.lastname: Rennie
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kwon
authors.forename: Robert A
authors.initials: RA
authors.lastname: Silverman
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000188:drug therapy*; D002985:Clinical Protocols; D017723:Drug Utilization Review; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D009519:New York City; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator