title: An expedited code stroke protocol is feasible and safe.
abstract: OBJECTIVE
  Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of < or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe.
  
  
  METHODS
  The expedited protocol includes: Benchmark onset-to-treatment within 2 hours; in-person triage of all code stroke patients; unmixed tissue plasminogen activator at the bedside during evaluation; no delays pending coagulation tests, chest x-ray, or stool guiac unless specifically indicated; and no delays pending formal CT interpretation or written consent.
  
  
  RESULTS
  Between July 2003 and June 2005, we evaluated 781 patients and treated 103 of 781 (13.2%) with intravenous recombinant tissue plasminogen activator within 3 hours. Of these, we treated 49 of 103 (47.6%) within 2 hours of symptom onset, and 54 of 103 (52.4%) between 2 and 3 hours. The overall risk of symptomatic intracerebral hemorrhage was 4 of 103 (3.9%; 95% CI, 1.1%, 9.6%), and not significantly different from 6.4% (P=0.42). The hemorrhage risks in those treated within 2 hours of symptom onset and those treated between 2 and 3 hours were not significantly different from each other or from 6.4%.
  
  
  CONCLUSIONS
  The expedited code stroke protocol is feasible and appears safe. Further study is warranted to confirm its safety and determine whether it results in better clinical outcomes.
authors.affiliation: Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Sattin
authors.forename: Scott E
authors.initials: SE
authors.lastname: Olson
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lyden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000379:methods / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator